Serial measurement of N-terminal pro-B-type natriuretic peptide and cardiac troponin T for cardiovascular disease risk assessment in the Multi-Ethnic Study of Atherosclerosis (MESA)

Abstract

Background: N-terminal-pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin T (TnT) predict cardiovascular disease (CVD) risk in a variety of populations. Whether their predictive value varies by ethnicity is unknown. We sought to determine whether NT-proBNP and TnT improve prediction of incident coronary heart disease (CHD) and CVD, independent of CVD risk factors, in a multiethnic population; whether NT-proBNP improves prediction compared with the Framingham Risk Score or the Pooled Cohort Risk Equation; and whether a second NT-proBNP further improves prediction.

Methods: Both NT-proBNP and TnT were measured in 5,592 MESA white, black, Hispanic, and Chinese participants (60% nonwhite; mean age 62.3 ± 10.3 years) in 2000 to 2002 and 2004 to 2005. We evaluated adjusted risk of incident CHD and CVD based on baseline and change in biomarker concentration.

Results: Participants were followed up through 2011 and incurred 370 CVD events (232 CHD). Concentrations of NT-proBNP and TnT varied by ethnicity. Both NT-proBNP and TnT were associated with an increased risk of events (adjusted hazard ratio [HR] for CHD [95% CI] for fifth quintile vs other 4 quintiles of NT-proBNP, 2.03 [1.50-2.76]; HR for CHD for detectable vs undetectable TnT, 3.95 [2.29-6.81]). N-terminal-pro-B-type natriuretic peptide improved risk prediction and classification compared with the Framingham Risk Score and the Pooled Cohort Risk Equation. Change in NT-proBNP was independently associated with events (HR for CHD per unit increase in ΔlogNT-proBNP, 1.95 [1.16-3.26]). None of the observed associations varied by ethnicity.

Conclusions: Both NT-proBNP and TnT are predictors of incident CHD, independent of established risk factors and ethnicity, in a multiethnic population without known CVD. Change in NT-proBNP may add additional prognostic information.

Trial registration: ClinicalTrials.gov NCT00005487.

Figure 1

Flow diagram of MESA participants

Figure 2

Adjusted hazard ratios for incident CHD (A) and CVD (B) by decile of NT-proBNP. Hazard ratios are adjusted for age, sex, race, current smoking (Y/N), family history of heart attack, diabetes, use of anti-hypertensive therapy, use of statin therapy, body mass index, systolic blood pressure, LDL-cholesterol, HDL-cholesterol, and glomerular filtration rate.

Figure 3

Kaplan-Meier plots based on quintile of NT-proBNP, by ethnicity. The plots show risk of incident CHD and CVD among (A, E) all participants, (B, F) non-Hispanic whites, (C, G) African Americans, and (D, H) Hispanics.

Figure 4

Incidence rate of CHD (A) and CVD (B) based on change in NT-proBNP. Change in NT-proBNP is defined among those with a baseline NT-proBNP ≥80 pg/ml as a decrease in NT-proBNP of at least 25% or an increase of at least 25% to a concentration ≥80 pg/ml. Change in NT-proBNP is defined among those with a baseline NT-proBNP <80 pg/ml as either a decline of at least 25% to a concentration <80 pg/mL or an increase of >25%.