1. Amino-terminal pro-B-type natriuretic peptide and high-sensitivity C-reactive protein but not cystatin C predict cardiovascular events in male patients with peripheral artery disease independently of ambulatory pulse pressure.
- Author
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Skoglund PH, Arpegård J, Ostergren J, and Svensson P
- Subjects
- Aged, Area Under Curve, Biomarkers blood, Chi-Square Distribution, Disease Progression, Disease-Free Survival, Humans, Male, Middle Aged, Multivariate Analysis, Myocardial Infarction etiology, Myocardial Infarction mortality, Myocardial Revascularization, Patient Admission, Peripheral Arterial Disease blood, Peripheral Arterial Disease complications, Peripheral Arterial Disease mortality, Peripheral Arterial Disease physiopathology, Predictive Value of Tests, Proportional Hazards Models, ROC Curve, Risk Assessment, Risk Factors, Sex Factors, Stroke etiology, Stroke mortality, Sweden, Time Factors, Blood Pressure, Blood Pressure Monitoring, Ambulatory, C-Reactive Protein metabolism, Cystatin C blood, Natriuretic Peptide, Brain blood, Peptide Fragments blood, Peripheral Arterial Disease diagnosis
- Abstract
Background: Patients with peripheral arterial disease (PAD) are at high risk for cardiovascular (CV) events. We have previously shown that ambulatory pulse pressure (APP) predicts CV events in PAD patients. The biomarkers amino-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), and cystatin C are related to a worse outcome in patients with CV disease, but their predictive values have not been studied in relation to APP., Methods: Blood samples and 24-hour measurements of ambulatory blood pressure were examined in 98 men referred for PAD evaluation during 1998-2001. Patients were followed for a median of 71 months. The outcome variable was CV events defined as either CV mortality or any hospitalization for myocardial infarction, stroke, or coronary revascularization. The predictive values of log(NT-proBNP), log(hs-CRP), and log(cystatin C) alone and together with APP were assessed by multivariable Cox regression. Area under the curve (AUC) and net reclassification improvement (NRI) were calculated compared with a model containing other significant risk factors., Results: During follow-up, 36 patients had at least 1 CV event. APP, log(NT-proBNP), and log(hs-CRP) all predicted CV events in univariable analysis, whereas log(cystatin C) did not. In multivariable analysis log(NT-proBNP) (hazard ratio (HR) = 1.62; 95% confidence interval (CI) = 1.05-2.51) and log(hs-CRP) (HR = 1.63; 95% CI = 1.19-2.24) predicted events independently of 24-hour PP. The combination of log(NT-proBNP), log(hs-CRP), and average day PP improved risk discrimination (AUC = 0.833 vs. 0.736; P < 0.05) and NRI (37%; P < 0.01) when added to other significant risk factors., Conclusions: NT-proBNP and hs-CRP predict CV events independently of APP and the combination of hs-CRP, NT-proBNP, and day PP improves risk discrimination in PAD patients.
- Published
- 2014
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