Abstract 1009: The Biomarker Nt-pro-BNP Substantially Improves Prediction of Death and First Major Cardiovascular Events in Primary Care Subjects: Results From the DETECT Study
Introduction: NT-pro-BNP serum levels, are well established risk predictors in patients (pts) with established coronary artery disease (CAD) or in pts.at risk for CAD: However, the incremental usefulness of adding NT-pro-BNP for predicting all-cause- mortality and first major cardiovascular events has not been evaluated among primary care subjects without known or suspected cardiovascular disease. Therefore, we investigated whether a single measurement of NT-pro-BNP serum levels improved risk stratification of a person beyond an assessment based on the established risk factors of cardiovascular disease (age, gender, BMI, hypercholesterinämia, arterial hypertension, diabetes and genetic disposition)
Methods: In a total of 4794 unselected healthy subjects of each age class between 18 and 85, within the 55.518 participants, of the cross-sectional, clinical-epidemiological DETECT study program, standardized clinical diagnostic assessment and measurements of serum biomarkers including NT-pro-BNP were performed. All subjects were followed up for 5 years.
Results: During the five year follow up period, 109 (2.27 %) died and 81 (1.69%) had a first major cardiovascular event (nonfatal myocardial infarction, revascularisation procedure by PCI or CABG). In COX proportional-hazards models adjusted for established risk factors for cardiovascular disease, NT-pro-BNP serum levels significantly predicted both, all-cause mortality (adjusted hazard ratio: 2.64, range 1.62– 4.28, p<0,0001) as well as first major CV event (adjusted hazard ratio: 2.64, range 1.55– 4,51, p<0,0001). The C statistic increased significantly, when NT-pro-BNP was incorporated into a model with established risk factors, both for all-cause mortality (0.832, p<0.0001) and for first major cardiovascular event (0.828, p<0.0001). The improvement in risk assessment remained strong, when estimated by other statistical methods, e.g. model discrimination and reclassification.
Conclusions: In subjects without known or suspected cardiovascular disease, the addition of a single measurement of NT-pro-BNP serum levels significantly improves risk stratification for death and first major CV events beyond that of a model, which is based only on established risk factors.