Elsevier

American Heart Journal

Volume 170, Issue 6, December 2015, Pages 1170-1183
American Heart Journal

Clinical Investigation
Serial measurement of N-terminal pro–B-type natriuretic peptide and cardiac troponin T for cardiovascular disease risk assessment in the Multi-Ethnic Study of Atherosclerosis (MESA)

https://doi.org/10.1016/j.ahj.2015.09.010Get rights and content

Background

N-terminal-pro–B-type natriuretic peptide (NT-proBNP) and cardiac troponin T (TnT) predict cardiovascular disease (CVD) risk in a variety of populations. Whether their predictive value varies by ethnicity is unknown. We sought to determine whether NT-proBNP and TnT improve prediction of incident coronary heart disease (CHD) and CVD, independent of CVD risk factors, in a multiethnic population; whether NT-proBNP improves prediction compared with the Framingham Risk Score or the Pooled Cohort Risk Equation; and whether a second NT-proBNP further improves prediction.

Methods

Both NT-proBNP and TnT were measured in 5,592 MESA white, black, Hispanic, and Chinese participants (60% nonwhite; mean age 62.3 ± 10.3 years) in 2000 to 2002 and 2004 to 2005. We evaluated adjusted risk of incident CHD and CVD based on baseline and change in biomarker concentration.

Results

Participants were followed up through 2011 and incurred 370 CVD events (232 CHD). Concentrations of NT-proBNP and TnT varied by ethnicity. Both NT-proBNP and TnT were associated with an increased risk of events (adjusted hazard ratio [HR] for CHD [95% CI] for fifth quintile vs other 4 quintiles of NT-proBNP, 2.03 [1.50-2.76]; HR for CHD for detectable vs undetectable TnT, 3.95 [2.29-6.81]). N-terminal-pro–B-type natriuretic peptide improved risk prediction and classification compared with the Framingham Risk Score and the Pooled Cohort Risk Equation. Change in NT-proBNP was independently associated with events (HR for CHD per unit increase in ΔlogNT-proBNP, 1.95 [1.16-3.26]). None of the observed associations varied by ethnicity.

Conclusions

Both NT-proBNP and TnT are predictors of incident CHD, independent of established risk factors and ethnicity, in a multiethnic population without known CVD. Change in NT-proBNP may add additional prognostic information.

Section snippets

Study population

MESA is a multicenter, prospective, population-based study that was designed to investigate the prevalence, correlates, and progression of subclinical CVD in asymptomatic individuals of 4 ethnicities in the United States. A detailed description of the study methods has been published previously.21 Briefly, between July 2000 and August 2002, 6,814 men and women who identified themselves as white, African American, Hispanic, or Chinese; were 45 to 84 years old; and were free of clinically apparent

Subject characteristics

The baseline characteristics of participants overall and by quintile of NT-proBNP are shown in Table I. The mean age was 62 ± 10 years, and 49% were male. Approximately one-quarter of participants were African American and one-quarter were Hispanic, whereas a higher percentage were non-Hispanic white and a lower percentage were Chinese American. Nearly half (48%) had a history of hypertension, and 13% had diabetes. The median NT-proBNP concentration was 54 pg/mL (24-112 pg/mL). Overall, 51% of

Discussion

In this large, multiethnic cohort of asymptomatic individuals, NT-proBNP is a significant independent predictor of incident CHD and CVD above and beyond clinical risk factors and provides complementary information to TnT and CAC score, irrespective of ethnicity. Furthermore, a second NT-proBNP measurement approximately 3 years later further improves prediction among all ethnic groups studied.

A few previous studies have evaluated the prognostic utility of serial NT-proBNP measurements. A study of

Conclusions

Among asymptomatic individuals of multiple ethnicities, NT-proBNP and TnT are significant, independent predictors of incident CHD and CVD above and beyond clinical risk factors. Change in NT-proBNP may provide additional prognostic information. Whether these biomarkers can meaningfully improve upon current methods of risk stratification for primary CVD prevention is not clear.

Sources of Funding

This research was supported by contracts N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, and N01-HC-95169 from the National Heart, Lung, and Blood Institute; by Grants UL1-TR-000040 and UL1-TR-001079 from NCRR; and by Roche Diagnostics. The authors thank the other investigators, the staff, and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be

Disclosures

Roche Diagnostics provided the reagents for the biomarker analyses in this study, but had no input into the study design, analyses, or manuscript. A.B., D.S., H.B., J.A.C.L., M.H.C., O.S., P.C., P.G., and R.P.T. have no disclosures. A.S.M. has received research support from Abbott, Alere, BG Medicine, Critical Diagnostic, Roche Diagnostics, and consulting fees from BG Medicine and Sphingotec. C.R.D. receives investigator-initiated grant support from Roche Diagnostics and Critical Diagnostics

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