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High-sensitivity C-reactive protein and N-terminal pro-B-type natriuretic peptide in patients with stable coronary

Marina J Harutyunyan1, Anders B Mathiasen, Per Winkel

  • 1Department of Medicine B, The Heart Centre, Rigshospitalet, Copenhagen University Hospital and Faculty of Health Sciences, Denmark.

Scandinavian Journal of Clinical and Laboratory Investigation
|November 27, 2010
PubMed

Insights

Serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a stronger predictor of adverse outcomes in stable coronary artery disease (CAD) than high-sensitivity C-reactive protein (hs-CRP). NT-proBNP alone effectively predicts myocardial infarction and cardiovascular death.

Area of Science:

  • Cardiology
  • Biomarker Discovery
  • Clinical Prognostics

Background:

  • Patients with stable coronary artery disease (CAD) face a significant risk of adverse events.
  • Identifying reliable prognostic biomarkers is crucial for managing stable CAD.
  • Existing biomarkers require further evaluation for their predictive capabilities in this population.

Purpose of the Study:

  • To assess the prognostic value of serum high-sensitivity C-reactive protein (hs-CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with stable CAD.
  • To determine if hs-CRP and NT-proBNP, alone or in combination, can predict major adverse cardiovascular events.
  • To compare the predictive power of hs-CRP and NT-proBNP for myocardial infarction (MI), cardiovascular death (CVD), and non-cardiovascular death.

Main Methods:

  • Analysis of data from the CLARICOR trial, including 4264 patients with stable CAD.
  • Prospective follow-up for 2.6 years to record occurrences of MI and death (cardiovascular and non-cardiovascular).
  • Statistical analysis using hazard ratios (HR) to evaluate the association of hs-CRP and NT-proBNP levels with adverse outcomes, with and without adjustments for other factors.

Main Results:

  • Serum NT-proBNP demonstrated a significant association with MI, CVD, and non-CVD events (HR > 1.6, p < 0.0005).
  • hs-CRP showed a weaker association with MI and CVD compared to NT-proBNP (HR 1.20 for MI, 1.39 for CVD).
  • After adjusting for NT-proBNP, hs-CRP's association was limited to non-CVD events, while NT-proBNP remained a significant predictor for MI, CVD, and non-CVD outcomes.

Conclusions:

  • Elevated serum NT-proBNP is a more potent predictor of MI, CVD, and non-CVD than hs-CRP in stable CAD patients.
  • hs-CRP does not significantly improve prognostic predictions when NT-proBNP levels are considered.
  • NT-proBNP is a valuable standalone biomarker for risk stratification in stable CAD.
Abstract

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