N-terminal pro-B-type natriuretic peptide is an independent predictor of cardiovascular morbidity and mortality in the general population

Abstract. de Boer RA, van Veldhuisen DJ, Gansevoort RT, Muller Kobold AC, van Gilst WH, Hillege HL, Bakker SJL, van der Harst P (University of Groningen). The fibrosis marker galectin-3 and outcome in the general population. J Intern Med 2012; 272: 55-64.Objective. Galectin-3 is involved in fibrosis and inflammation and plays a role in heart failure, renal disease, obesity and cancer. We aimed to establish the relationship between galectin-3 and cardiovascular (CV) risk factors and mortality in the general population.Design and subjects. This study included 7968 subjects from the Prevention of REnal and Vascular ENd-stage Disease (PREVEND) cohort, with a median follow-up of approximately 10 years. Plasma galectin-3 was measured in baseline samples.Main outcome measures. We investigated the relationships between galectin-3 levels, demographic characteristics and risk factors of CV disease. We determined the prognostic value for all-cause, CV and cancer mortality.Results. The mean age of the population was 50 ± 13 years. Mean blood pressure was 129 ⁄ 74 mmHg, mean cholesterol was 5.7 ± 1.1 mmol L )1 and median galectin-3 was 10.9 ng mL )1 [interquartile range (IQR) 9.0-13.1]. Galectin-3 levels correlated with a wide range of risk factors of CV disease, including blood pressure, serum lipids, body mass index, renal function and N-terminal pro-B-type natriuretic peptide (P < 0.0001). We observed a strong association between galectin-3 and age. Furthermore, we found a gender interaction, with female subjects (n = 4001) having higher median galectin-3 levels (11.0 ng mL )1 , IQR 9.1-13.4 vs. men (n = 3967) 10.7 ng mL )1 , IQR 8.9-12.8; P < 0.0001), and galectin-3 levels in women more strongly correlated with risk factors of CV disease. After correction for the classical CV risk factors (smoking, blood pressure, cholesterol and diabetes), galectin-3 levels independently predicted all-cause mortality (hazard ratio per SD galectin-3 1.09, 95% CI 1.01-1.19; P = 0.036), but not CV and cancer mortality separately.Conclusions. Galectin-3 is associated with age and risk factors of CV disease, with a strong gender interaction for these correlations. Galectin-3 predicts all-cause mortality in the general population.

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“…The PREVEND study has been described in detail elsewhere [15,16]. During the period 1997-1998, 8592 subjects were enrolled in the PREVEND cohort.…”

Section: Prevendmentioning

confidence: 99%

“…A C-reactive protein level >3 mg L )1 was defined as elevated. N-terminal pro-B-type natriuretic peptide (NTproBNP) (pg mL ) was measured as previously described [16]. UAE was calculated as the average value from two consecutive 24-h urine collections.…”

Section: Measurement Of Galectin-3mentioning

confidence: 99%

The fibrosis marker galectin‐3 and outcome in the general population

Boer¹,

Veldhuisen²,

Gansevoort³

et al. 2011

Journal of Internal Medicine

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“…Indeed some clinical guidelines have started to recommend testing for such biomarkers in clinical settings [2], although the use of C-reactive protein for widespread testing remains debatable [1]. In a number of general population, primary prevention and high-risk cohort studies, NT-proBNP has been shown to be strongly associated with risk of CVD and appears to have prognostic value over and above that of traditional risk factors [3][4][5][6][7][8][9]. However, the ability of NT-proBNP to predict cardiovascular events in specific conditions such as type 2 diabetes is less extensively studied.…”

Section: Introductionmentioning

confidence: 99%

N-terminal pro-brain natriuretic peptide and risk of cardiovascular events in older patients with type 2 diabetes: the Edinburgh Type 2 Diabetes Study

et al. 2014

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Aims/hypothesis The aim of this study was to investigate the association of N-terminal pro-brain natriuretic peptide (NTproBNP) with traditional cardiovascular risk factors and incident cardiovascular events in older people with type 2 diabetes. Methods In the prospective phase of the Edinburgh Type 2 Diabetes Study, 1066 men and women aged 60 to 75 years with type 2 diabetes mellitus were followed for 4 years; 112 participants had an incident cardiovascular event. At baseline, cardiovascular risk factors, pre-existing cardiovascular disease and levels of NT-proBNP were evaluated. Results Raised plasma NT-proBNP levels were associated with these classical cardiovascular risk factors: increased duration of diabetes, use of insulin, raised BMI, reduced HDLcholesterol, reduced renal function and use of lipid-lowering and anti-hypertensive medication (all p < 0.05). In the prospective analysis, NT-proBNP was strongly associated with subsequent risk of all cardiovascular disease events (HR per one SD increase in NT-proBNP 1.39; 95% CI 1.10, 1.75), independent of cardiovascular risk factors traditionally used to predict vascular events. NT-proBNP was also independently associated with incident coronary artery disease events (1.48, 95% CI 1.10, 1.98). The addition of NTproBNP to multivariate models improved the C-index by 0.019 for the 'hard' cardiac endpoint (fatal and non-fatal myocardial infarction). Conclusions/interpretation In older people with type 2 diabetes, NT-proBNP is associated with the development of coronary and cerebrovascular events, independent of a wide range of other vascular and metabolic risk factors, and may prove a useful addition to current vascular risk scores in diabetes populations.

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“…PREVEND is a population-based prospective cohort study primarily aimed at investigating the natural course of increased levels of urinary albumin excretion (UAE) and its association with long-term renal and cardiovascular outcomes in the general population. Details of the design and methodology of the study have been published elsewhere [15][16][17][18]. In summary, in the period 1997-1998, all inhabitants of the city of Groningen, the Netherlands, aged 28-75 years were sent a one-page postal questionnaire and a vial to collect an early morning urine sample (n = 85,421).…”

Section: Study Populationmentioning

confidence: 99%

Should non-cardiovascular mortality be considered in the SCORE model? Findings from the Prevention of Renal and Vascular End-stage Disease (PREVEND) cohort

et al. 2014

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Document VersionPublisher's PDF, also known as Version of Record (includes final page, issue and volume numbers) Please check the document version of this publication:• A submitted manuscript is the author's version of the article upon submission and before peer-review. There can be important differences between the submitted version and the official published version of record. People interested in the research are advised to contact the author for the final version of the publication, or visit the DOI to the publisher's website.• The final author version and the galley proof are versions of the publication after peer review.• The final published version features the final layout of the paper including the volume, issue and page numbers. Link to publication General rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal ? Take down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Abstract Competing non-cardiovascular related deaths were not accounted for in the Systematic COronary Risk Evaluation (SCORE) model. In this study we assessed the impact of non-cardiovascular related deaths on the prognostic performance and yield of the SCORE model. 5,752 participants from the Prevention of Renal and Vascular End stage Disease cohort aged 40 years and older who were free of atherosclerotic cardiovascular disease (CVD) at baseline were included. A cause-specific hazards (CSH) CVD-related mortality prediction model that accounted for non-CVD-related deaths was developed. The prognostic performance of this model was then compared with a refitted SCORE model. During a median follow-up period of 12.5 years, 139 CVD and 495 non-CVD-related deaths were reported. Discriminatory performance was comparable between the models (Cindex = 0.64). The models showed good calibration although the CSH model underestimated risk in the highest decile while the refitted SCORE model showed overestimation. The CSH model classified more non-events into the low risk group compared to the refitted SCORE model (n = 51), yet it was accompanied by a misclassification of six events into the low risk group. The refitted SCORE model classified more individuals as high risk. However, the potential overtreatment that may result from utilizing the refitted SCORE model, when compared with the CSH model, still falls within acceptable limits. Our findings do not support the incorporation of noncar...

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N-terminal pro-B-type natriuretic peptide is an independent predictor of cardiovascular morbidity and mortality in the general population

Abstract: In this large community-based cohort, plasma NT-proBNP was a strong predictor of death and a wide range of CV events.

Cited by 112 publications

References 34 publications

The fibrosis marker galectin‐3 and outcome in the general population

The fibrosis marker galectin‐3 and outcome in the general population

N-terminal pro-brain natriuretic peptide and risk of cardiovascular events in older patients with type 2 diabetes: the Edinburgh Type 2 Diabetes Study

Should non-cardiovascular mortality be considered in the SCORE model? Findings from the Prevention of Renal and Vascular End-stage Disease (PREVEND) cohort

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