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B-type natriuretic peptide and C-reactive protein in the prediction of atrial fibrillation risk: the CHARGE-AF Consortium of community-based cohort studies.

TitleB-type natriuretic peptide and C-reactive protein in the prediction of atrial fibrillation risk: the CHARGE-AF Consortium of community-based cohort studies.
Publication TypeJournal Article
Year of Publication2014
AuthorsSinner, MF, Stepas, KA, Moser, CB, Krijthe, BP, Aspelund, T, Sotoodehnia, N, Fontes, JD, A Janssens, CJW, Kronmal, RA, Magnani, JW, Witteman, JC, Chamberlain, AM, Lubitz, SA, Schnabel, RB, Vasan, RS, Wang, TJ, Agarwal, SK, McManus, DD, Franco, OH, Yin, X, Larson, MG, Burke, GL, Launer, LJ, Hofman, A, Levy, D, Gottdiener, JS, Kääb, S, Couper, D, Harris, TB, Astor, BC, Ballantyne, CM, Hoogeveen, RC, Arai, AE, Soliman, EZ, Ellinor, PT, Stricker, BHC, Gudnason, V, Heckbert, SR, Pencina, MJ, Benjamin, EJ, Alonso, A
Date Published2014 Oct
KeywordsAged, Atrial Fibrillation, Biomarkers, C-Reactive Protein, Europe, Female, Humans, Incidence, Male, Natriuretic Peptide, Brain, Peptide Fragments, Predictive Value of Tests, Risk Assessment, Risk Factors, United States
Abstract<p><b>AIMS: </b>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.</p><p><b>METHODS AND RESULTS: </b>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, χ(2) = 17.0; CRP, χ(2) = 10.5; BNP and CRP, χ(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.</p><p><b>CONCLUSION: </b>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.</p>
Alternate JournalEuropace
PubMed ID25037055
PubMed Central IDPMC4197895
Grant List1RC1HL101056] / HL / NHLBI NIH HHS / United States
K24 HL105780 / HL / NHLBI NIH HHS / United States
R01 HL092577 / HL / NHLBI NIH HHS / United States