Natriuretic peptides and integrated risk assessment for cardiovascular disease: an individual-participant-data meta-analysis

被引：168

作者：

Willeit, Peter ^{[1
,2
]}

Kaptoge, Stephen ^{[1
]}

Welsh, Paul ^{[3
]}

Butterworth, Adam S. ^{[1
]}

Chowdhury, Rajiv ^{[1
]}

Spackman, Sarah A. ^{[1
]}

Pennells, Lisa ^{[1
]}

Gao, Pei ^{[1
,4
]}

Burgess, Stephen ^{[1
]}

Freitag, Daniel F. ^{[1
]}

Sweeting, Michael ^{[1
]}

Wood, Angela M. ^{[1
]}

Cook, Nancy R. ^{[5
,6
]}

Judd, Suzanne ^{[7
]}

Trompet, Stella ^{[8
]}

Nambi, Vijay ^{[9
,10
]}

Olsen, Michael Hecht ^{[11
]}

Everett, Brendan M. ^{[5
,6
]}

Kee, Frank ^{[12
]}

Arnlov, Johan ^{[13
]}

Salomaa, Veikko ^{[14
]}

Levy, Daniel ^{[15
]}

Kauhanen, Jussi ^{[16
]}

Laukkanen, Jari A. ^{[16
]}

Kavousi, Maryam ^{[17
]}

Ninomiya, Toshiharu ^{[18
]}

Casas, Juan-Pablo ^{[19
]}

Daniels, Lori B. ^{[20
]}

Lind, Lars ^{[13
]}

Kistorp, Caroline N. ^{[21
,22
]}

Rosenberg, Jens ^{[23
]}

Mueller, Thomas ^{[24
]}

Rubattu, Speranza ^{[25
,26
]}

Panagiotakos, Demosthenes B. ^{[27
]}

Franco, Oscar H. ^{[17
]}

de Lemos, James A. ^{[28
]}

Luchner, Andreas ^{[29
,30
]}

Kizer, Jorge R. ^{[31
]}

Kiechl, Stefan ^{[2
]}

Salonen, Jukka T. ^{[32
]}

Wannamethee, S. Goya ^{[33
]}

de Boer, Rudolf A. ^{[34
]}

Nordestgaard, Borge G. ^{[21
]}

Andersson, Jonas ^{[35
]}

Jorgensen, Torben ^{[36
]}

Melander, Olle ^{[37
]}

Ballantyne, Christie M. ^{[10
,38
]}

DeFilippi, Christopher ^{[39
]}

Ridker, Paul M. ^{[5
,6
]}

Cushman, Mary ^{[40
]}

机构：

[1] Univ Cambridge, Cambridge, England

[2] Med Univ Innsbruck, Innsbruck, Austria

[3] Univ Glasgow, Glasgow, Lanark, Scotland

[4] Peking Univ, Beijing, Peoples R China

[5] Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA

[6] Harvard Med Sch, Boston, MA 02115 USA

[7] Univ Alabama Birmingham, Birmingham, AL 35487 USA

[8] Leiden Univ, Med Ctr, Leiden, Netherlands

[9] Michael E DeBakey Baylor Coll Med, Houston, TX 77030 USA

[10] Houston Methodist DeBakey Heart & Vasc Ctr, Houston, TX 77030 USA

[11] Odense Univ Hosp, Odense, Denmark

[12] Queens Univ Belfast, Belfast, Antrim, North Ireland

[13] Uppsala Univ, Uppsala, Sweden

[14] Natl Inst Hlth & Welf, Helsinki, Finland

[15] NIH, Bldg 10, Bethesda, MD 20892 USA

[16] Univ Eastern Finland, Kuopio, Finland

[17] Erasmus MC, Rotterdam, Netherlands

[18] Kyushu Univ, Fukuoka, Japan

[19] UCL, Farr Inst Hlth Informat, London, England

[20] Univ Calif San Diego, San Diego, CA 92103 USA

[21] Univ Copenhagen, Copenhagen, Denmark

[22] Herlev Hosp, Copenhagen, Denmark

[23] Copenhagen Univ Hosp, Glostrup, Denmark

[24] Konventhosp Barmherzige Bruder, Linz, Austria

[25] Univ Roma La Sapienza, Rome, Italy

[26] Ist Ricovero & Cura Carattere Sci Neuromed, Pozzilli, Italy

[27] Harokopio Univ Athens, Athens, Greece

[28] Univ Texas Southwestern Med Sch, Dallas, TX 75390 USA

[29] Univ Klinikum Regensburg, Regensburg, Germany

[30] Klinikum St Marien, Amberg, Germany

[31] Albert Einstein Coll Med, Bronx, NY 10467 USA

[32] Metab Analyt Serv, Helsinki, Finland

[33] UCL, London, England

[34] Univ Groningen, Univ Med Ctr Groningen, Groningen, Netherlands

[35] Umea Univ, Umea, Sweden

[36] Res Ctr Prevent & Hlth, Glostrup, Denmark

[37] Malmo Univ Hosp, Malmo, Sweden

[38] Baylor Coll Med, Houston, TX 77030 USA

[39] Univ Maryland, Sch Med, Baltimore, MD 21201 USA

[40] Univ Vermont, Burlington, VT 05405 USA

[41] Univ N Carolina, Chapel Hill, NC 27514 USA

[42] Icelandic Heart Assoc, Kopavogur, Iceland

[43] Univ Iceland, Reykjavik, Iceland

[44] Univ Glasgow, Glasgow, Lanark, Scotland

来源：

LANCET DIABETES & ENDOCRINOLOGY | 2016年 / 4卷 / 10期

基金：

欧洲研究理事会; 英国医学研究理事会;

关键词：

C-REACTIVE PROTEIN; ASSOCIATION TASK-FORCE; HEART-FAILURE; NT-PROBNP; GENERAL-POPULATION; COST-EFFECTIVENESS; TROPONIN-T; COLLABORATIVE CARE; ACCF/AHA GUIDELINE; EVENTS;

D O I：

10.1016/S2213-8587(16)30196-6

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Guidelines for primary prevention of cardiovascular diseases focus on prediction of coronary heart disease and stroke. We assessed whether or not measurement of N-terminal-pro-B-type natriuretic peptide (NT-proBNP) concentration could enable a more integrated approach than at present by predicting heart failure and enhancing coronary heart disease and stroke risk assessment. Methods In this individual-participant-data meta-analysis, we generated and harmonised individual-participant data from relevant prospective studies via both de-novo NT-proBNP concentration measurement of stored samples and collection of data from studies identified through a systematic search of the literature (PubMed, Scientific Citation Index Expanded, and Embase) for articles published up to Sept 4, 2014, using search terms related to natriuretic peptide family members and the primary outcomes, with no language restrictions. We calculated risk ratios and measures of risk discrimination and reclassification across predicted 10 year risk categories (ie, <5%, 5% to <7.5%, and >= 7.5%), adding assessment of NT-proBNP concentration to that of conventional risk factors (ie, age, sex, smoking status, systolic blood pressure, history of diabetes, and total and HDL cholesterol concentrations). Primary outcomes were the combination of coronary heart disease and stroke, and the combination of coronary heart disease, stroke, and heart failure. Findings We recorded 5500 coronary heart disease, 4002 stroke, and 2212 heart failure outcomes among 95617 participants without a history of cardiovascular disease in 40 prospective studies. Risk ratios (for a comparison of the top third vs bottom third of NT-proBNP concentrations, adjusted for conventional risk factors) were 1.76 (95% CI 1.56-1.98) for the combination of coronary heart disease and stroke and 2.00 (1.77-2.26) for the combination of coronary heart disease, stroke, and heart failure. Addition of information about NT-proBNP concentration to a model containing conventional risk factors was associated with a C-index increase of 0.012 (0.010-0.014) and a net reclassification improvement of 0.027 (0.019-0.036) for the combination of coronary heart disease and stroke and a C-index increase of 0.019 (0.016-0.022) and a net reclassification improvement of 0.028 (0.019-0.038) for the combination of coronary heart disease, stroke, and heart failure. Interpretation In people without baseline cardiovascular disease, NT-proBNP concentration assessment strongly predicted first-onset heart failure and augmented coronary heart disease and stroke prediction, suggesting that NT-proBNP concentration assessment could be used to integrate heart failure into cardiovascular disease primary prevention. Copyright (C) 2016 The Author(s). Published by Elsevier Ltd

引用

页码：840 / 849

页数：10

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