Comparison of NT-proBNP with C-Reactive Protein and Urinary Albumin Levels in the Prediction of Total Mortality in the General Population
Abstract Number: 1005-P
Authors: CAROLINE KISTORP, ILAN RAYMOND, FRANTS PEDERSEN, JENS FABER, PER HILDEBRANDT
Institutions: Frederiksberg, Copenhagen, Denmark
Results: C-reactive protein and urinary albumin are known risk factors for cardiovascular mortality. Brain natriuretic peptide (BNP) including the prohormone N-terminal pro BNP (NT-proBNP) is important prognostic predictors in patients with heart failure (HF) and ischemic heart disease (IHD). Thus, the purpose of this study was to compare the prognostic value of NT-proBNP with these two biological markers in the general population. We conducted a prospective study including 658 subjects (age 51-90 years), consecutively recruited from general practitioners. The participants were followed for a median of 37 month (range 2 - 49). Plasma NT-proBNP, HsCRP and urinary albumin excretion, as urinary A/C (albumin/creatinine) ratio were measured at baseline. All subjects underwent echocardiography assessing left ventricular ejection fraction (LVEF). The prognostic value of these tree measurements was tested in Cox regression models, including traditional risk factors, history of HF, IHD and diabetes, as well as clinical features. During follow-up there were 55 (8.4 %) deaths from any cause. The mortality risk was associated with increasing quartiles for NT-proBNP, HsCRP and urinary A/C ratio (P for trend < 0.0001). Subjects in the highest quartile of NT-proBNP had a hazard ratio of 3.8 (95 % CI: 2.0-7.3, P < 0.0001) adjusted for age and sex as compared with subjects in the lowest quartile, the hazard ratio was 3.1 (1.6 - 6.1, P<0.001) after complete adjustment for risk factors and LVEF. The corresponding hazard ratios of the highest quartiles of HsCRP and urinary A/C ratio were 1.6 (0.9 - 2.9, P = 0.09) and 1.9 (1.1 - 3.5, P = 0.024) after complete adjustment, versus 3.0 (1.6- 5.8, P < 0.001) and 2.6 (1.5 - 4.8, P<0.001) after adjustment, respectively. This study demonstrates, that in the general population high levels of plasma NT-proBNP, HsCRP and urinary A/C ratio independently predicts mortality. NT-proBNP was superior in identifying high-risk subjects, highlighting its usefulness for risk stratification in the general population.