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.
Bibliographical noteFunding Information:
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 found at http://www.mesa-nhlbi.org .
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 and consulting/honorarium from Roche Diagnostics, Siemens, Radiometer, and HDL. L.B.D. has received research supplies from Critical Diagnostics and speaking fees from Roche Diagnostics and Critical Diagnostics and has served as a consultant for diaDexus and Alere. M.C. received grant funding from diaDexus and is consultant to Daiichi Sankyo and Merck.
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