UMMS Affiliation

Department of Medicine; Meyers Primary Care Institute; Department of Quantitative Health Sciences

Date

10-1-2014

Document Type

Article

Disciplines

Biological Factors | Cardiology | Cardiovascular Diseases | Epidemiology | Genetics | Molecular Genetics

Abstract

AIMS: B-type natriuretic peptide (BNP) and C-reactive protein (CRP) predict atrial fibrillation (AF) risk. However, their risk stratification abilities in the broad community remain uncertain. We sought to improve risk stratification for AF using biomarker information.

METHODS AND RESULTS: We ascertained AF incidence in 18 556 Whites and African Americans from the Atherosclerosis Risk in Communities Study (ARIC, n=10 675), Cardiovascular Health Study (CHS, n = 5043), and Framingham Heart Study (FHS, n = 2838), followed for 5 years (prediction horizon). We added BNP (ARIC/CHS: N-terminal pro-B-type natriuretic peptide; FHS: BNP), CRP, or both to a previously reported AF risk score, and assessed model calibration and predictive ability [C-statistic, integrated discrimination improvement (IDI), and net reclassification improvement (NRI)]. We replicated models in two independent European cohorts: Age, Gene/Environment Susceptibility Reykjavik Study (AGES), n = 4467; Rotterdam Study (RS), n = 3203. B-type natriuretic peptide and CRP were significantly associated with AF incidence (n = 1186): hazard ratio per 1-SD ln-transformed biomarker 1.66 [95% confidence interval (CI), 1.56-1.76], P < 0.0001 and 1.18 (95% CI, 1.11-1.25), P < 0.0001, respectively. Model calibration was sufficient (BNP, chi(2) = 17.0; CRP, chi(2) = 10.5; BNP and CRP, chi(2) = 13.1). B-type natriuretic peptide improved the C-statistic from 0.765 to 0.790, yielded an IDI of 0.027 (95% CI, 0.022-0.032), a relative IDI of 41.5%, and a continuous NRI of 0.389 (95% CI, 0.322-0.455). The predictive ability of CRP was limited (C-statistic increment 0.003). B-type natriuretic peptide consistently improved prediction in AGES and RS.

CONCLUSION: B-type natriuretic peptide, not CRP, substantially improved AF risk prediction beyond clinical factors in an independently replicated, heterogeneous population. B-type natriuretic peptide may serve as a benchmark to evaluate novel putative AF risk biomarkers. Cardiology 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Rights and Permissions

Citation: Europace. 2014 Oct;16(10):1426-33. doi: 10.1093/europace/euu175. Link to article on publisher's site

Comments

Full author list omitted for brevity. For the full list of authors, see article.

Published by Oxford University Press on behalf of the European Society of Cardiology 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US

Related Resources

Link to Article in PubMed

PubMed ID

25037055

 
 

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