Clinical InvestigationSerial 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)
Section snippets
Study population
MESA is a multicenter, prospective, population-based study that was designed to investigate the prevalence, correlates, and progression of subclinical CVD in asymptomatic individuals of 4 ethnicities in the United States. A detailed description of the study methods has been published previously.21 Briefly, between July 2000 and August 2002, 6,814 men and women who identified themselves as white, African American, Hispanic, or Chinese; were 45 to 84 years old; and were free of clinically apparent
Subject characteristics
The baseline characteristics of participants overall and by quintile of NT-proBNP are shown in Table I. The mean age was 62 ± 10 years, and 49% were male. Approximately one-quarter of participants were African American and one-quarter were Hispanic, whereas a higher percentage were non-Hispanic white and a lower percentage were Chinese American. Nearly half (48%) had a history of hypertension, and 13% had diabetes. The median NT-proBNP concentration was 54 pg/mL (24-112 pg/mL). Overall, 51% of
Discussion
In this large, multiethnic cohort of asymptomatic individuals, NT-proBNP is a significant independent predictor of incident CHD and CVD above and beyond clinical risk factors and provides complementary information to TnT and CAC score, irrespective of ethnicity. Furthermore, a second NT-proBNP measurement approximately 3 years later further improves prediction among all ethnic groups studied.
A few previous studies have evaluated the prognostic utility of serial NT-proBNP measurements. A study of
Conclusions
Among asymptomatic individuals of multiple ethnicities, NT-proBNP and TnT are significant, independent predictors of incident CHD and CVD above and beyond clinical risk factors. Change in NT-proBNP may provide additional prognostic information. Whether these biomarkers can meaningfully improve upon current methods of risk stratification for primary CVD prevention is not clear.
Sources of Funding
This research was supported by contracts N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, and N01-HC-95169 from the National Heart, Lung, and Blood Institute; by Grants UL1-TR-000040 and UL1-TR-001079 from NCRR; and by Roche Diagnostics. The authors thank the other investigators, the staff, and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be
Disclosures
Roche Diagnostics provided the reagents for the biomarker analyses in this study, but had no input into the study design, analyses, or manuscript. A.B., D.S., H.B., J.A.C.L., M.H.C., O.S., P.C., P.G., and R.P.T. have no disclosures. A.S.M. has received research support from Abbott, Alere, BG Medicine, Critical Diagnostic, Roche Diagnostics, and consulting fees from BG Medicine and Sphingotec. C.R.D. receives investigator-initiated grant support from Roche Diagnostics and Critical Diagnostics
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Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005487.