Abstract 14801: B-type Natriuretic Peptides and Incident Cardiovascular Disease in a Multiethnic Cohort of Women

Abstract

Background: Few studies have examined the value of adding B-type natriuretic peptides in risk prediction algorithms, particularly among middle-aged women, who are at lower absolute risk for cardiovascular disease than similarly aged men.

Methods and Results: Using a prospective case-cohort approach within the multiethnic Women’s Health Initiative Observational Cohort, we selected 1821 incident cases of CVD (746 myocardial infarction, 754 ischemic strokes, 160 hemorrhagic strokes, 161 other CVD deaths) and a randomly selected subcohort of 1992 women free of CVD. As anticipated, median (IQR) levels of NT-proBNP were higher at study entry among incident cases [120.3 (68.1, 219.5)] than among controls [100.4 (59.7, 172.6), P<0.0001]. In proportional hazards models adjusted for age and race, each 1 SD unit of logarithm-transformed NT-proBNP was associated with a 39% increase in the risk of CVD (HR 1.39, 95% CI 1.29-1.50, P<0.0001). Similar associations were observed after further adjustment for Adult Treatment Panel-III (ATP-III) [HR 1.37 (1.26-1.48) P<0.0001] and Reynolds Risk Score [1.32 (1.22-1.44) P<0.0001] covariates. We observed statistically significant improvements in the C-statistic, net reclassification improvement (NRI), categoryless NRI, and integrated discrimination improvement when NT-proBNP levels were added to both the ATP-III and Reynolds Risk Score CVD risk prediction algorithms (Table).

Conclusions: In this multiethnic cohort of women with a substantial number of cardiovascular events, NT-proBNP improved measures of CVD risk prediction.