TIMI Study Group, 350 Longwood Avenue, Boston, MA 02115, USA.
J Rheumatol. 2011 Jun;38(6):1071-8. doi: 10.3899/jrheum.100880. Epub 2011 Apr 1.
Patients with arthritis frequently are at increased risk for future cardiovascular (CV) events. We investigated the performance of the cardiac biomarkers N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high sensitivity C-reactive protein (hsCRP) for predicting CV events in patients with arthritis taking chronic nonsteroidal antiinflammatory drugs (NSAID).
We evaluated 2-year CV outcomes in a prospective, nested biomarker study among patients (N = 6273) with rheumatoid arthritis and osteoarthritis treated with NSAID in the MEDAL (Multinational Etoricoxib and Diclofenac Arthritis Long-term) trial. Patients were stratified by quartiles of baseline NT-proBNP and established cutpoints of NT-proBNP and hsCRP.
NT-proBNP demonstrated a strong graded relationship with CV outcomes, including CV death (p for trend < 0.0001), myocardial infarction (MI) (p for trend = 0.02), heart failure (HF) (p for trend < 0.0001), and a composite of thrombotic events (CV death, MI, stroke) or HF (p for trend < 0.0001). Baseline levels of hsCRP were not associated with CV events (CV death/MI/stroke/HF; p for trend = 0.65). NT-proBNP remained strongly predictive of CV events after adjustment for age, sex, diabetes, hypertension, hyperlipidemia, smoking, type of arthritis, body mass index, creatinine clearance, history of CV disease, and hsCRP (CV death/MI/stroke/HF: Q4 vs Q1 hazard ratio 3.53, 95% CI 1.89-6.58). Patients with a NT-proBNP level below 100 pg/ml had a 0.94% rate of thrombotic events or heart failure at 2 years.
NT-proBNP is a simple and robust noninvasive indicator of CV risk in patients with arthritis. Risk stratification based on NT-proBNP may facilitate identification of patients with arthritis who are at low CV risk during chronic NSAID treatment.
关节炎患者未来发生心血管（CV）事件的风险通常会增加。我们研究了心脏生物标志物 N 末端脑利钠肽前体（NT-proBNP）和高敏 C 反应蛋白（hsCRP）在接受慢性非甾体抗炎药（NSAID）治疗的关节炎患者中预测 CV 事件的性能。
我们在 MEDAL（多国家依托考昔和双氯芬酸关节炎长期）试验中，对接受 NSAID 治疗的类风湿关节炎和骨关节炎患者进行了一项前瞻性、嵌套生物标志物研究，评估了 2 年的 CV 结局。患者按基线 NT-proBNP 的四分位数和 NT-proBNP 和 hsCRP 的既定切点分层。
NT-proBNP 与 CV 结局呈强分级关系，包括 CV 死亡（趋势检验 P<0.0001）、心肌梗死（MI）（趋势检验 P=0.02）、心力衰竭（HF）（趋势检验 P<0.0001）和血栓事件（CV 死亡、MI、中风）或 HF 的复合终点（趋势检验 P<0.0001）。hsCRP 的基线水平与 CV 事件无关（CV 死亡/MI/中风/HF；趋势检验 P=0.65）。调整年龄、性别、糖尿病、高血压、高血脂、吸烟、关节炎类型、体重指数、肌酐清除率、CV 病史和 hsCRP 后，NT-proBNP 仍然是 CV 事件的强预测因素（CV 死亡/MI/中风/HF：Q4 与 Q1 的危险比为 3.53，95%CI 为 1.89-6.58）。NT-proBNP 水平低于 100 pg/ml 的患者在 2 年内发生血栓事件或心力衰竭的概率为 0.94%。
NT-proBNP 是关节炎患者 CV 风险的简单而强大的无创指标。基于 NT-proBNP 的风险分层可能有助于确定接受慢性 NSAID 治疗时 CV 风险较低的关节炎患者。
