Document Detail

Assessment of conventional cardiovascular risk factors and multiple biomarkers for the prediction of incident heart failure and atrial fibrillation.
MedLine Citation:
PMID:  21070922     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: the purpose of this study was to assess the predictive accuracy of conventional cardiovascular risk factors for incident heart failure and atrial fibrillation, and the added benefit of multiple biomarkers reflecting diverse pathophysiological pathways.
BACKGROUND: heart failure and atrial fibrillation are interrelated cardiac diseases associated with substantial morbidity and mortality and increasing incidence. Data on prediction and prevention of these diseases in healthy individuals are limited.
METHODS: in 5,187 individuals from the community-based MDCS (Malmö Diet and Cancer Study), we studied the performance of conventional risk factors and 6 biomarkers including midregional pro-atrial natriuretic peptide (MR-proANP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), midregional pro-adrenomedullin, cystatin C, C-reactive protein (CRP), and copeptin.
RESULTS: during a mean follow-up of 14 years, 112 individuals were diagnosed with heart failure and 284 individuals with atrial fibrillation. NT-proBNP (hazard ratio [HR]: 1.63 per SD, 95% confidence interval [CI]: 1.29 to 2.06, p < 0.001), CRP (HR: 1.57 per SD, 95% CI: 1.28 to 1.94, p < 0.001), and MR-proANP (HR: 1.26 per SD, 95% CI: 1.02 to 1.56, p = 0.03) predicted incident heart failure independently of conventional risk factors and other biomarkers. MR-proANP (HR: 1.62, 95% CI: 1.42 to 1.84, p < 0.001) and CRP (HR: 1.18, 95% CI: 1.03 to 1.34, p = 0.01) independently predicted atrial fibrillation. Addition of biomarkers to conventional risk factors improved c-statistics from 0.815 to 0.842 for heart failure and from 0.732 to 0.753 for atrial fibrillation and the integrated discrimination improvement for both diseases (p < 0.001). Net reclassification improvement (NRI) with biomarkers was observed in 22% of individuals for heart failure (NRI, p < 0.001) and in 7% for atrial fibrillation (NRI, p = 0.06), mainly due to up-classification of individuals who developed disease (heart failure: 29%, atrial fibrillation: 19%). Addition of CRP to natriuretic peptides did not improve discrimination or reclassification.
CONCLUSIONS: conventional cardiovascular risk factors predict incident heart failure and atrial fibrillation with reasonable accuracy in middle-age individuals free from disease. Natriuretic peptides, but not other biomarkers, improve discrimination modestly for both diseases above and beyond conventional risk factors and substantially improve risk classification for heart failure.
J Gustav Smith; Christopher Newton-Cheh; Peter Almgren; Joachim Struck; Nils G Morgenthaler; Andreas Bergmann; Pyotr G Platonov; Bo Hedblad; Gunnar Engström; Thomas J Wang; Olle Melander
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  56     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-12     Completed Date:  2011-01-11     Revised Date:  2014-09-08    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1712-9     Citation Subset:  AIM; IM    
Copyright Information:
2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Aged, 80 and over
Atrial Fibrillation / blood,  complications,  epidemiology*
Atrial Natriuretic Factor / blood
Biological Markers / blood*
C-Reactive Protein / metabolism
Confidence Intervals
Follow-Up Studies
Heart Failure / blood,  complications,  epidemiology*
Middle Aged
Natriuretic Peptide, Brain / blood
Odds Ratio
Peptide Fragments / blood
Prospective Studies
Protein Precursors
ROC Curve
Risk Assessment / methods*
Risk Factors
Sweden / epidemiology
Time Factors
Grant Support
K23 HL074077/HL/NHLBI NIH HHS; K23 HL074077-05/HL/NHLBI NIH HHS; K23 HL080025/HL/NHLBI NIH HHS; K23 HL080025-05/HL/NHLBI NIH HHS; K23-HL-080025/HL/NHLBI NIH HHS; R01-DK-081572/DK/NIDDK NIH HHS; R01-HL-083197/HL/NHLBI NIH HHS; R01-HL-086875/HL/NHLBI NIH HHS
Reg. No./Substance:
0/Biological Markers; 0/Peptide Fragments; 0/Protein Precursors; 0/midregional pro-atrial natriuretic peptide, human; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain; 85637-73-6/Atrial Natriuretic Factor; 9007-41-4/C-Reactive Protein

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