Baseline concentrations of N-terminal B-type natriuretic peptide (NT-proBNP) in women had a positive association with the occurrence of a first major cardiovascular event, according to a new study published in the Journal of the American College of Cardiology.
The relationship was consistent across subgroups with different levels of risk. Including NT-proBNP concentrations to risk algorithms significantly improved the identification of women at increased risk for developing cardiovascular disease (CVD).
The researchers examined a multiethnic cohort of postmenopausal women, aged 50 to 79 years at recruitment, who were enrolled in the Women’s Health Initiative. Among these women, 1,821 had their NT-proBNP concentrations measured at baseline and subsequently had a major cardiovascular (CV) event, which was defined as myocardial infarction (MI), stroke or CV death. Baseline levels of NT-proBNP were also measured in a reference cohort of 1,992 women.
The risk for CVD was increased by 53% among the women in the highest quartile of NT-proBNP (≥140.8 ng/L) vs. those in the lowest quartile after adjusting for traditional risk factors (P for trend<.0001).
NT-proBNP was positively associated with MI (P for trend=.008), stroke (P for trend<.0001) and CV death (P for trend<.0001). The association held for both fatal and nonfatal coronary and cerebrovascular events, when considered separately, and it was consistent across several subgroups.
Adding NT-proBNP to risk prediction models that use traditional risk covariables led to consistent and statistically significant improvements in c-statistic (P=.0003), categorical net reclassification (P<.0001) and integrated discrimination (P<.0001). The researchers found similar results when adding NT-proBNP to the Reynolds Risk Score.
The authors noted the modest nature of these improvements in measures of risk prediction, explaining that natriuretic peptides may be useful as markers of CVD risk for patients for whom the decision to add preventive statins is unclear. However, the authors stated that, for a healthy patient with an elevated level of natriuretic peptides, the therapeutic response is unclear.
In an accompanying editorial, authors stated several features indicating that the study’s findings of the consistent, though modest, relationship between NT-proBNP and incident CV events are significant.2 These features include the linear relationship between NT-proBNP and incident CV events, the consistency of the hazard ratios across several methods of adjustment, the ability of NT-proBNP levels to predict each individual component of the composite endpoint and no interactions with any other cardiac risk factor or patient descriptor.
The editorial concludes by considering the impact of NT-proBNP on patient-related health and economic outcomes. The authors state that an assay of NT-proBNP meets the criteria of demonstrating technical excellence, high test performance and significant changes in diagnostic thinking, but that the study lacks the data to alter therapeutic strategy.
They state that this study’s “data cannot take us further in implementing this knowledge to improve patient care.”