Abstract
Background:
Statin trials targeting low- to intermediate-risk individuals, namely MEGA, JUPITER, and HOPE-3, have demonstrated benefit of statin use for primary prevention of atherosclerotic cardiovascular disease (ASCVD), but are poorly reflected in guideline recommendations for primary prevention of ASCVD. N-terminal pro-B-type natriuretic peptide (NT-proBNP) may refine ASCVD risk in low-to intermediate-risk individuals eligible for HOPE-3, JUPITER and MEGA, and aid statin initiation in low- to intermediate-risk populations.
Methods:
5434 participants, aged 45 years and above from the prospective population-based Rotterdam Study, free of ASCVD, heart failure, and diabetes, were included between 1997 and 2008. Eligibility criteria for MEGA, JUPITER, and HOPE-3 trials were checked for each participant. ASCVD event rates, hazard ratios (HR), 5-year numbers needed to treat (NNT5y), and screen (NNS5y) per trial eligible population and NT-proBNP category (≤50, 50-100, and >100 pg/mL) were calculated.
Results:
Median age was 61.6 years, 58.9% were women, median NT-proBNP was 60 pg/mL. The proportions of participants eligible for MEGA, JUPITER and HOPE-3 were 34.9%, 10.4% and 23.7%. Incidence rates per 1000 person-years for ASCVD were 10.4 (95%CI: 60.1-67.9) for MEGA, 16.8 (95%CI: 13.6-20.6) for JUPITER, and 12.1 (95%CI: 10.3-14) for HOPE-3. Adjusted HR in trial eligible individuals for NT-proBNP >100 pg/mL compared to ≤50 pg/mL level were 1.73 (95%CI: 1.21-2.47), 1.46 (95%CI: 0.80-2.66) and 1.50 (95%CI: 0.99-2.26), respectively. Estimated NNT5y among trial eligible individuals with NT-proBNP levels >100 pg/mL based on high-intensity statin treatment, varied from 23 to 34 to prevent one ASCVD event, while NNS5y ranged between 56 and 134.
Conclusions:
NT-proBNP level >100 pg/mL identifies individuals at the highest ASCVD risk among low- to intermediate-risk populations who are likely to benefit from statin treatment at acceptable NNT5y and NNS5y.
Statin trials targeting low- to intermediate-risk individuals, namely MEGA, JUPITER, and HOPE-3, have demonstrated benefit of statin use for primary prevention of atherosclerotic cardiovascular disease (ASCVD), but are poorly reflected in guideline recommendations for primary prevention of ASCVD. N-terminal pro-B-type natriuretic peptide (NT-proBNP) may refine ASCVD risk in low-to intermediate-risk individuals eligible for HOPE-3, JUPITER and MEGA, and aid statin initiation in low- to intermediate-risk populations.
Methods:
5434 participants, aged 45 years and above from the prospective population-based Rotterdam Study, free of ASCVD, heart failure, and diabetes, were included between 1997 and 2008. Eligibility criteria for MEGA, JUPITER, and HOPE-3 trials were checked for each participant. ASCVD event rates, hazard ratios (HR), 5-year numbers needed to treat (NNT5y), and screen (NNS5y) per trial eligible population and NT-proBNP category (≤50, 50-100, and >100 pg/mL) were calculated.
Results:
Median age was 61.6 years, 58.9% were women, median NT-proBNP was 60 pg/mL. The proportions of participants eligible for MEGA, JUPITER and HOPE-3 were 34.9%, 10.4% and 23.7%. Incidence rates per 1000 person-years for ASCVD were 10.4 (95%CI: 60.1-67.9) for MEGA, 16.8 (95%CI: 13.6-20.6) for JUPITER, and 12.1 (95%CI: 10.3-14) for HOPE-3. Adjusted HR in trial eligible individuals for NT-proBNP >100 pg/mL compared to ≤50 pg/mL level were 1.73 (95%CI: 1.21-2.47), 1.46 (95%CI: 0.80-2.66) and 1.50 (95%CI: 0.99-2.26), respectively. Estimated NNT5y among trial eligible individuals with NT-proBNP levels >100 pg/mL based on high-intensity statin treatment, varied from 23 to 34 to prevent one ASCVD event, while NNS5y ranged between 56 and 134.
Conclusions:
NT-proBNP level >100 pg/mL identifies individuals at the highest ASCVD risk among low- to intermediate-risk populations who are likely to benefit from statin treatment at acceptable NNT5y and NNS5y.
| Original language | English |
|---|---|
| Pages (from-to) | 2070-2072 |
| Number of pages | 3 |
| Journal | Circulation |
| Volume | 150 |
| Issue number | 25 |
| DOIs | |
| Publication status | Published - 16 Dec 2024 |
