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Amino-terminal pro-B-type natriuretic peptide improves discrimination for incident atherosclerotic cardiovascular disease beyond ambulatory blood pressure in elderly men
Dalarna University, School of Education, Health and Social Studies, Medical Science.ORCID iD: 0000-0002-6933-4637
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2015 (English)In: Hypertension, ISSN 0194-911X, E-ISSN 1524-4563, Vol. 66, no 3, 681-686 p.Article in journal (Refereed) Published
Abstract [en]

Improvement of risk prediction for atherosclerotic cardiovascular disease (ASCVD) is needed. Both ambulatory blood pressure (ABP) and biomarkers amino-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein and cystatin C improve risk prediction but they have not been evaluated in relation to each other. We analyzed whether NT-proBNP, high-sensitivity C-reactive protein, or cystatin C improved risk prediction beyond traditional ASCVD risk factors combined with 24-hour systolic BP (SBP). Secondary aim was to evaluate whether ABP improved risk prediction when compared with models with the biomarkers. We followed up 907 70-year-old men, free of baseline disease, for incident ASCVD defined as fatal or nonfatal myocardial infarction or fatal or nonfatal stroke for a median of 10 years. Cox regression was used to estimate the association between variables in the models and incident ASCVD. Biomarkers were added to a model containing both traditional risk factors and ABP and the models were compared on C-statistics and net reclassification improvement. Twenty-four hour SBP improved discrimination for incident ASCVD when compared with office SBP in a traditional risk factor model (area under the receiver-operating characteristic curve, +2.4%). NT-proBNP further improved reclassification (+18.7%-19.9%; P<0.01) when added to ABP models, whereas high-sensitivity C-reactive protein and cystatin C did not. Twenty-four hour SBP significantly improved net reclassification when added to a traditional risk factor model that included NT-proBNP. The combination of 24-hour SBP and NT-proBNP improved discrimination and net reclassification for incident ASCVD when compared with office SBP in elderly men. NT-proBNP, but not high-sensitivity C-reactive protein or cystatin C, improved risk prediction and discrimination when added to a model that included ABP.

Place, publisher, year, edition, pages
2015. Vol. 66, no 3, 681-686 p.
Keyword [en]
aged; B-type natriuretic peptide; blood-brain barrier; blood pressure monitoring; ambulatory; C-reactive protein; cardiovascular diseases; cystatin c; longitudinal studies
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Clinical Medicine
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Identifiers
URN: urn:nbn:se:du-18991DOI: 10.1161/HYPERTENSIONAHA.115.05717ISI: 000359664700033PubMedID: 26150437OAI: oai:DiVA.org:du-18991DiVA: diva2:845503
Available from: 2015-08-12 Created: 2015-08-12 Last updated: 2015-09-04Bibliographically approved

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CiteExportLink to record
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Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
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More styles
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  • Other locale
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