Prognostic value of NT-pro-BNP and hs-CRP for risk stratification in primary care: results from the population-based DETECT study

• Published in: Clinical research in cardiology 2013-04, Vol.102 (4), p.259-268
• Main Authors: Leistner, David M., Klotsche, Jens, Pieper, Lars, Palm, Sylvia, Stalla, Günter K., Lehnert, Hendrik, Silber, Sigmund, März, Winfried, Wittchen, Hans-Ulrich, Zeiher, Andreas M.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers - metabolism; C-Reactive Protein - metabolism; Cardiology; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Cardiovascular Diseases - physiopathology; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Medicine; Medicine & Public Health; Middle Aged; Natriuretic Peptide, Brain - metabolism; Original Paper; Outcome Assessment (Health Care); Peptide Fragments - metabolism; Predictive Value of Tests; Primary Health Care - methods; Prognosis; Prospective Studies; Risk Factors; Young Adult
• ISSN: 1861-0684; 1861-0692
• DOI: 10.1007/s00392-012-0530-5

Background There is continuous debate to the use of biomarkers in the general practitioners office and to what degree the established biomarkers N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and high-sensitive C-reactive protein (hs-CRP) might contribute to improved prediction of incident cardiovascular events. Objective To evaluate the utility and 5-year predictive value of a single measurement of NT-pro-BNP and hs-CRP for incident cardiovascular events, and its added value beyond the contribution of conventional risk factors in primary care. Methods Five year prospective longitudinal clinical epidemiological study in a nationwide sample of 4,775 primary care subjects (mean age 55.8 years, 62 % women) without coronary artery disease at baseline. Main outcome measures were incident major cardiovascular events and all-cause death. Results During the 5 years of follow-up, 188 subjects (3.9 %) died or experienced a first major cardiovascular event. The addition of NT-pro-BNP, but not of hs-CRP to a prediction model with established cardiovascular risk factors improved the prediction of major cardiovascular events (increase in C statistic by 0.009; p  = 0.008), and was associated with a significant improvement in net reclassification improvement (NRI = 23.6 %; p  = 0.003). Conclusion In a primary care setting, one single measurement of NT-pro-BNP, but not of hs-CRP significantly improves the prediction of incident cardiovascular events.