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

Vijay Nambi; Christie M. Ballantyne; Ron C. Hoogeveen; Sunil K. Agarwal; Demosthenes B. Panagiotakos; S. Goya Wannamethee; Peter H. Whincup; Stefan Kiechl; Johann Willeit; Georg Schett; Peter Santer; Peter Willeit; Juan Pablo Casas; Debbie A. Lawlor; Christopher DeFilippi; Richard A. Kronmal; Bruce M. Psaty; Mary Cushman; Børge G. Nordestgaard; Michael Hecht Olsen; Torben Jørgensen; James A. de Lemos; Darren K. McGuire; Sandeep R. Das; Mark H. Drazner; Veikko Salomaa; Erkki Vartiainen; Kennet Harald; Tanja Zeller; Daniel Levy; Toshiharu Ninomiya; Jun Hata; Yutaka Kiyohara; Jussi Kauhanen; Jukka T. Salonen; Jari A. Laukkanen; Tomi Pekka Tuomainen; Heikki Ruskoaho; Caroline N. Kistorp; Ilan Raymond; Thomas Mueller; Benjamin Dieplinger; Meinhard Haltmayer; Rudolf A. de Boer; Maryam Kavousi; Albert Hofman; Symen Ligthart; Abbas Dehghan; Frank J.A. van Rooij; M. Arfan Ikram

doi:10.1016/S2213-8587(16)30196-6

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

Vijay Nambi, Christie M. Ballantyne, Ron C. Hoogeveen, Sunil K. Agarwal, Demosthenes B. Panagiotakos, S. Goya Wannamethee, Peter H. Whincup, Stefan Kiechl, Johann Willeit, Georg Schett, Peter Santer, Peter Willeit, Juan Pablo Casas, Debbie A. Lawlor, Christopher DeFilippi, Richard A. Kronmal, Bruce M. Psaty, Mary Cushman, Børge G. Nordestgaard, Michael Hecht OlsenTorben Jørgensen, James A. de Lemos, Darren K. McGuire, Sandeep R. Das, Mark H. Drazner, Veikko Salomaa, Erkki Vartiainen, Kennet Harald, Tanja Zeller, Daniel Levy, Toshiharu Ninomiya, Jun Hata, Yutaka Kiyohara, Jussi Kauhanen, Jukka T. Salonen, Jari A. Laukkanen, Tomi Pekka Tuomainen, Heikki Ruskoaho, Caroline N. Kistorp, Ilan Raymond, Thomas Mueller, Benjamin Dieplinger, Meinhard Haltmayer, Rudolf A. de Boer, Maryam Kavousi, Albert Hofman, Symen Ligthart, Abbas Dehghan, Frank J.A. van Rooij, M. Arfan Ikram

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Abstract

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 95 617 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.

Original language	English
Pages (from-to)	840-849
Number of pages	10
Journal	The Lancet Diabetes and Endocrinology
Volume	4
Issue number	10
DOIs	https://doi.org/10.1016/S2213-8587(16)30196-6
Publication status	Published - 1 Oct 2016

Bibliographical note

Publisher Copyright:
© 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license

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Nambi, V., Ballantyne, C. M., Hoogeveen, R. C., Agarwal, S. K., Panagiotakos, D. B., Wannamethee, S. G., Whincup, P. H., Kiechl, S., Willeit, J., Schett, G., Santer, P., Willeit, P., Casas, J. P., Lawlor, D. A., DeFilippi, C., Kronmal, R. A., Psaty, B. M., Cushman, M., Nordestgaard, B. G., ... Ikram, M. A. (2016). Natriuretic peptides and integrated risk assessment for cardiovascular disease: an individual-participant-data meta-analysis. The Lancet Diabetes and Endocrinology, 4(10), 840-849. https://doi.org/10.1016/S2213-8587(16)30196-6

@article{c3e2206bc9ff448aaf1252d6c7a628e6,

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

abstract = "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 95 617 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. ",

author = "Vijay Nambi and Ballantyne, \{Christie M.\} and Hoogeveen, \{Ron C.\} and Agarwal, \{Sunil K.\} and Panagiotakos, \{Demosthenes B.\} and Wannamethee, \{S. Goya\} and Whincup, \{Peter H.\} and Stefan Kiechl and Johann Willeit and Georg Schett and Peter Santer and Peter Willeit and Casas, \{Juan Pablo\} and Lawlor, \{Debbie A.\} and Christopher DeFilippi and Kronmal, \{Richard A.\} and Psaty, \{Bruce M.\} and Mary Cushman and Nordestgaard, \{B{\o}rge G.\} and Olsen, \{Michael Hecht\} and Torben J{\o}rgensen and \{de Lemos\}, \{James A.\} and McGuire, \{Darren K.\} and Das, \{Sandeep R.\} and Drazner, \{Mark H.\} and Veikko Salomaa and Erkki Vartiainen and Kennet Harald and Tanja Zeller and Daniel Levy and Toshiharu Ninomiya and Jun Hata and Yutaka Kiyohara and Jussi Kauhanen and Salonen, \{Jukka T.\} and Laukkanen, \{Jari A.\} and Tuomainen, \{Tomi Pekka\} and Heikki Ruskoaho and Kistorp, \{Caroline N.\} and Ilan Raymond and Thomas Mueller and Benjamin Dieplinger and Meinhard Haltmayer and \{de Boer\}, \{Rudolf A.\} and Maryam Kavousi and Albert Hofman and Symen Ligthart and Abbas Dehghan and \{van Rooij\}, \{Frank J.A.\} and Ikram, \{M. Arfan\}",

note = "Publisher Copyright: {\textcopyright} 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license",

year = "2016",

month = oct,

day = "1",

doi = "10.1016/S2213-8587(16)30196-6",

language = "English",

volume = "4",

pages = "840--849",

journal = "The Lancet Diabetes and Endocrinology",

issn = "2213-8587",

publisher = "UniCeSV - Universita degli Studi di Firenze",

number = "10",

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Nambi, V, Ballantyne, CM, Hoogeveen, RC, Agarwal, SK, Panagiotakos, DB, Wannamethee, SG, Whincup, PH, Kiechl, S, Willeit, J, Schett, G, Santer, P, Willeit, P, Casas, JP, Lawlor, DA, DeFilippi, C, Kronmal, RA, Psaty, BM, Cushman, M, Nordestgaard, BG, Olsen, MH, Jørgensen, T, de Lemos, JA, McGuire, DK, Das, SR, Drazner, MH, Salomaa, V, Vartiainen, E, Harald, K, Zeller, T, Levy, D, Ninomiya, T, Hata, J, Kiyohara, Y, Kauhanen, J, Salonen, JT, Laukkanen, JA, Tuomainen, TP, Ruskoaho, H, Kistorp, CN, Raymond, I, Mueller, T, Dieplinger, B, Haltmayer, M, de Boer, RA , Kavousi, M , Hofman, A, Ligthart, S, Dehghan, A, van Rooij, FJA & Ikram, MA 2016, 'Natriuretic peptides and integrated risk assessment for cardiovascular disease: an individual-participant-data meta-analysis', The Lancet Diabetes and Endocrinology, vol. 4, no. 10, pp. 840-849. https://doi.org/10.1016/S2213-8587(16)30196-6

TY - JOUR

T1 - Natriuretic peptides and integrated risk assessment for cardiovascular disease

T2 - an individual-participant-data meta-analysis

AU - Nambi, Vijay

AU - Ballantyne, Christie M.

AU - Hoogeveen, Ron C.

AU - Agarwal, Sunil K.

AU - Panagiotakos, Demosthenes B.

AU - Wannamethee, S. Goya

AU - Whincup, Peter H.

AU - Kiechl, Stefan

AU - Willeit, Johann

AU - Schett, Georg

AU - Santer, Peter

AU - Willeit, Peter

AU - Casas, Juan Pablo

AU - Lawlor, Debbie A.

AU - DeFilippi, Christopher

AU - Kronmal, Richard A.

AU - Psaty, Bruce M.

AU - Cushman, Mary

AU - Nordestgaard, Børge G.

AU - Olsen, Michael Hecht

AU - Jørgensen, Torben

AU - de Lemos, James A.

AU - McGuire, Darren K.

AU - Das, Sandeep R.

AU - Drazner, Mark H.

AU - Salomaa, Veikko

AU - Vartiainen, Erkki

AU - Harald, Kennet

AU - Zeller, Tanja

AU - Levy, Daniel

AU - Ninomiya, Toshiharu

AU - Hata, Jun

AU - Kiyohara, Yutaka

AU - Kauhanen, Jussi

AU - Salonen, Jukka T.

AU - Laukkanen, Jari A.

AU - Tuomainen, Tomi Pekka

AU - Ruskoaho, Heikki

AU - Kistorp, Caroline N.

AU - Raymond, Ilan

AU - Mueller, Thomas

AU - Dieplinger, Benjamin

AU - Haltmayer, Meinhard

AU - de Boer, Rudolf A.

AU - Kavousi, Maryam

AU - Hofman, Albert

AU - Ligthart, Symen

AU - Dehghan, Abbas

AU - van Rooij, Frank J.A.

AU - Ikram, M. Arfan

PY - 2016/10/1

Y1 - 2016/10/1

N2 - 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 95 617 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.

AB - 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 95 617 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.

UR - https://www.scopus.com/pages/publications/84990052413

U2 - 10.1016/S2213-8587(16)30196-6

DO - 10.1016/S2213-8587(16)30196-6

M3 - Article

C2 - 27599814

AN - SCOPUS:84990052413

SN - 2213-8587

VL - 4

SP - 840

EP - 849

JO - The Lancet Diabetes and Endocrinology

JF - The Lancet Diabetes and Endocrinology

IS - 10

ER -

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

Abstract

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