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New risk markers may change the HeartScore risk classification significantly in one-fifth of the population

Journal of Human Hypertension volume 23, pages 105–112 (2009)Cite this article

Abstract

The study aim was to determine whether urine albumin/creatinine ratio (UACR), high-sensitivity C-reactive protein (hsCRP) or N-terminal pro-brain natriuretic peptide (Nt-proBNP) added to risk prediction based on HeartScore and history of diabetes or cardiovascular disease. A Danish population sample of 2460 individuals was divided in three groups: 472 subjects receiving cardiovascular medication or having history of diabetes, prior myocardial infarction or stroke, 559 high-risk subjects with a 10-year risk of cardiovascular death above 5% as estimated by HeartScore, and 1429 low-moderate risk subjects with estimated risk below 5%. During the following 9.5 years the composite end point of cardiovascular death, non-fatal myocardial infarction or stroke (CEP) occurred in 204 subjects. CEP was predicted in all three groups by UACR (HRs: 2.1, 2.1 and 2.3 per 10-fold increase, all P<0.001) or by hsCRP (HRs: 1.9, 1.9 and 1.7 per 10-fold increase, all P<0.05), but not by Nt-proBNP (HRs: 1.1, 2.6 and 3.7 per 10-fold increase, last two P<0.001) (P<0.05 for interaction). In the low-moderate risk group, pre-specified gender adjusted (men/women) cutoff values of UACR⩾0.73/1.06 mg mmol−1 or hsCRP⩾6.0/7.3 mg l−1 identified a subgroup of 16% who experienced one-third of the CEPs. In the patient group, combined absence of high UACR and high Nt-proBNP⩾110/164 pg ml−1 (men/women) identified a subgroup of 52% who experienced only 15% of the CEPs. Additional use of UACR and hsCRP in subjects with low-moderate risk and UACR and Nt-proBNP in subjects with known diabetes of cardiovascular disease changed HeartScore risk classification significantly in 19% of the population.

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Acknowledgements

Analyses of N-terminal pro-brain natriuretic peptide and high-sensitivity C-reactive protein were supported by Roche Diagnostics, Mannheim, Germany.

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Authors and Affiliations

  1. Research Center for Prevention and Health, Glostrup, Denmark

    M H Olsen

  2. Department of Internal Medicine, Frederiksberg University Hospital, Frederiksberg, Denmark

    M H Olsen, M K Christensen & P R Hildebrandt

  3. Department of Clinical Physiology and Nuclear Medicine, Frederiksberg University Hospital, Frederiksberg, Denmark

    T W Hansen & S Rasmussen

  4. Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark

    F Gustafsson & K Wachtell

  5. Department of Internal Medicine, Holbæk Hospital, Holbæk, Denmark

    H Ibsen

  6. Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark

    C Torp-Pedersen

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  1. M H Olsen
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  4. F Gustafsson
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  9. P R Hildebrandt
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Correspondence to M H Olsen.

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None of the others have any conflicts of interest. The principal investigator had full access to the data.

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Olsen, M., Hansen, T., Christensen, M. et al. New risk markers may change the HeartScore risk classification significantly in one-fifth of the population. J Hum Hypertens 23, 105–112 (2009). https://doi.org/10.1038/jhh.2008.112

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