Kara Kaffer, Mahabadi Amir A, Berg Marie H, Lehmann Nils, Möhlenkamp Stefan, Kälsch Hagen, Bauer Marcus, Moebus Susanne, Dragano Nico, Jöckel Karl-Heinz, Neumann Till, Erbel Raimund
West-German Heart Center, Department of Cardiology, University of Duisburg-Essen, Essen, Germany
West-German Heart Center, Department of Cardiology, University of Duisburg-Essen, Essen, Germany.
Eur J Prev Cardiol. 2014 Sep;21(9):1171-9. doi: 10.1177/2047487313490256. Epub 2013 May 14.
Several biomarkers including B-type natriuretic peptide (BNP) have been suggested to improve prediction of coronary events and all-cause mortality. Moreover, coronary artery calcium (CAC) as marker of subclinical atherosclerosis is a strong predictor for cardiovascular mortality and morbidity. We aimed to evaluate the predictive ability of BNP and CAC for all-cause mortality and coronary events above traditional cardiovascular risk factors (TRF) in the general population.
We followed 3782 participants of the population-based Heinz Nixdorf Recall cohort study without coronary artery disease at baseline for 7.3 ± 1.3 years. Associations of BNP and CAC with incident coronary events and all-cause mortality were assessed using Cox regression, Harrell's c, and time-dependent integrated discrimination improvement (IDI(t), increase in explained variance).
Subjects with high BNP levels had increased frequency of coronary events and death (coronary events/mortality: 14.1/28.2% for BNP ≥100 pg/ml vs. 2.7/5.5% for BNP < 100 pg/ml, respectively). Subjects with a BNP ≥100 pg/ml had increased incidence of hard endpoints sustaining adjustment for CAC and TRF (for coronary events: hazard ratio (HR) (95% confidence interval (CI)) 3.41(1.78-6.53); for all-cause mortality: HR 3.35(2.15-5.23)). Adding BNP to TRF and CAC increased measures of predictive ability: coronary events (Harrell's c, for coronary events, 0.775-0.784, p = 0.09; for all-cause mortality 0.733-0.740, p = 0.04; and IDI(t) (95% CI), for coronary events: 2.79% (0.33-5.65%) and for all-cause mortality 1.78% (0.73-3.10%).
Elevated levels of BNP are associated with excess incident coronary events and all-cause mortality rates, with BNP and CAC significantly and complementary improving prediction of risk in the general population above TRF.
包括B型利钠肽（BNP）在内的多种生物标志物已被认为可改善对冠状动脉事件和全因死亡率的预测。此外，冠状动脉钙化（CAC）作为亚临床动脉粥样硬化的标志物，是心血管疾病死亡率和发病率的有力预测指标。我们旨在评估在一般人群中，BNP和CAC相较于传统心血管危险因素（TRF）对全因死亡率和冠状动脉事件的预测能力。
我们对基于人群的海因茨·尼克斯多夫召回队列研究中的3782名基线时无冠状动脉疾病的参与者进行了7.3±1.3年的随访。使用Cox回归、Harrell's c以及时间依赖性综合判别改善指标（IDI(t)，解释方差增加）评估BNP和CAC与冠状动脉事件及全因死亡率之间的关联。
BNP水平高的受试者发生冠状动脉事件和死亡的频率增加（冠状动脉事件/死亡率：BNP≥100 pg/ml者分别为14.1%/28.2%，而BNP＜100 pg/ml者分别为2.7%/5.5%）。BNP≥100 pg/ml的受试者在对CAC和TRF进行调整后，发生硬终点事件的发生率增加（冠状动脉事件：风险比（HR）（95%置信区间（CI））为3.41（1.78 - 6.53）；全因死亡率：HR为3.35（2.15 - 5.23））。将BNP添加到TRF和CAC中可提高预测能力指标：冠状动脉事件（Harrell's c，冠状动脉事件方面，从0.775提高到0.784，p = 0.09；全因死亡率方面，从0.733提高到0.740，p = 0.04；IDI(t)（95% CI），冠状动脉事件方面：2.79%（0.33 - 5.65%），全因死亡率方面：1.78%（0.73 - 3.10%））。
BNP水平升高与冠状动脉事件和全因死亡率增加相关，BNP和CAC显著且互补地改善了一般人群中高于TRF的风险预测。
