Abstract
Background
There is continuous debate to the use of biomarkers in the general practitioners office and to what degree the established biomarkers N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and high-sensitive C-reactive protein (hs-CRP) might contribute to improved prediction of incident cardiovascular events.
Objective
To evaluate the utility and 5-year predictive value of a single measurement of NT-pro-BNP and hs-CRP for incident cardiovascular events, and its added value beyond the contribution of conventional risk factors in primary care.
Methods
Five year prospective longitudinal clinical epidemiological study in a nationwide sample of 4,775 primary care subjects (mean age 55.8 years, 62 % women) without coronary artery disease at baseline. Main outcome measures were incident major cardiovascular events and all-cause death.
Results
During the 5 years of follow-up, 188 subjects (3.9 %) died or experienced a first major cardiovascular event. The addition of NT-pro-BNP, but not of hs-CRP to a prediction model with established cardiovascular risk factors improved the prediction of major cardiovascular events (increase in C statistic by 0.009; p = 0.008), and was associated with a significant improvement in net reclassification improvement (NRI = 23.6 %; p = 0.003).
Conclusion
In a primary care setting, one single measurement of NT-pro-BNP, but not of hs-CRP significantly improves the prediction of incident cardiovascular events.
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Acknowledgments
All authors have carefully read and approved the manuscript in its present form. None of the authors have any conflict of interest pertaining to the data presented, or have published or submitted any related papers from the same study. DETECT (Diabetes Cardiovascular Risk-Evaluation: Targets and Essential Data for Commitment of Treatment) is a cross-sectional and prospective-longitudinal, nationwide clinical epidemiological study. DETECT is supported by an unrestricted educational grant of Pfizer GmbH, Karlsruhe, Germany. Members of the DETECT-Study group include: Principal investigator: Professor Dr. H.-U. Wittchen; Staff members: Dipl.-Psych. L. Pieper, Dipl.-Math. J. Klotsche, Dr. T. Eichler, Dr. H. Glaesmer, E. Katze. Steering Committee: Professor Dr. H. Lehnert (Lübeck), Professor Dr. G. K. Stalla (München), Professor Dr. A. M. Zeiher (Frankfurt); Advisory Board: Professor Dr. W. März (Heidelberg/Graz), Professor Dr. S. Silber (München), Professor Dr. Dr. U. Koch (Hamburg), Priv.-Doz. Dr. D. Pittrow (München/Dresden), Professor Dr. M. Wehling (Mannheim), Dr. D. Leistner (Frankfurt), Dr. H. J. Schneider (München), Dr. C. Sievers (München).
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Leistner, D.M., Klotsche, J., Pieper, L. et al. Prognostic value of NT-pro-BNP and hs-CRP for risk stratification in primary care: results from the population-based DETECT study. Clin Res Cardiol 102, 259–268 (2013). https://doi.org/10.1007/s00392-012-0530-5
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DOI: https://doi.org/10.1007/s00392-012-0530-5