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

Moritz F. Sinner, Katherine A. Stepas, Carlee B. Moser, Bouwe P. Krijthe, Thor Aspelund, Nona Sotoodehnia, João D. Fontes, A. Cecile J.W. Janssens, Richard A. Kronmal, Jared W. Magnani, Jacqueline C. Witteman, Alanna Chamberlain, Steven A. Lubitz, Renate B. Schnabel, Ramachandran S. Vasan, Thomas J. Wang, Sunil K. Agarwal, David D. McManus, Oscar H. Franco, Xiaoyan YinMartin G. Larson, Gregory L. Burke, Lenore J. Launer, Albert Hofman, Daniel Levy, John S. Gottdiener, Stefan Kääb, David Couper, Tamara B. Harris, Brad C. Astor, Christie M. Ballantyne, Ron C. Hoogeveen, Andrew E. Arai, Elsayed Z. Soliman, Patrick T. Ellinor, Bruno H.C. Stricker, Vilmundur Gudnason, Susan R. Heckbert, Michael J. Pencina, Emelia J. Benjamin, Alvaro Alonso

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Aims: 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. Methods and results: 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 [Cstatistic, 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, χ2 = 17.0; CRP, χ2 = 10.5; BNP and CRP, χ2 = 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. Conclusion: 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. Published by Oxford University Press on behalf of the European Society of Cardiology 2014.

Original languageEnglish (US)
Pages (from-to)1426-1433
Number of pages8
JournalEuropace
Volume16
Issue number10
DOIs
StatePublished - Jan 1 2014

Fingerprint

Brain Natriuretic Peptide
C-Reactive Protein
Atrial Fibrillation
Cohort Studies
Confidence Intervals
Biomarkers
Calibration
polypeptide C
Benchmarking
Incidence
African Americans
Genes
Atherosclerosis

Keywords

  • Atrial fibrillation
  • B-type natriuretic peptide
  • Biomarker
  • C-reactive protein
  • Epidemiology
  • Risk prediction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Sinner, M. F., Stepas, K. A., Moser, C. B., Krijthe, B. P., Aspelund, T., Sotoodehnia, N., ... Alonso, A. (2014). B-type natriuretic peptide and C-reactive protein in the prediction of atrial fibrillation risk: The CHARGE-AF Consortium of community-based cohort studies. Europace, 16(10), 1426-1433. https://doi.org/10.1093/europace/euu175

B-type natriuretic peptide and C-reactive protein in the prediction of atrial fibrillation risk : The CHARGE-AF Consortium of community-based cohort studies. / Sinner, Moritz F.; Stepas, Katherine A.; Moser, Carlee B.; Krijthe, Bouwe P.; Aspelund, Thor; Sotoodehnia, Nona; Fontes, João D.; Janssens, A. Cecile J.W.; Kronmal, Richard A.; Magnani, Jared W.; Witteman, Jacqueline C.; Chamberlain, Alanna; Lubitz, Steven A.; Schnabel, Renate B.; Vasan, Ramachandran S.; Wang, Thomas J.; Agarwal, Sunil K.; McManus, David D.; Franco, Oscar H.; Yin, Xiaoyan; Larson, Martin G.; Burke, Gregory L.; Launer, Lenore J.; Hofman, Albert; Levy, Daniel; Gottdiener, John S.; Kääb, Stefan; Couper, David; Harris, Tamara B.; Astor, Brad C.; Ballantyne, Christie M.; Hoogeveen, Ron C.; Arai, Andrew E.; Soliman, Elsayed Z.; Ellinor, Patrick T.; Stricker, Bruno H.C.; Gudnason, Vilmundur; Heckbert, Susan R.; Pencina, Michael J.; Benjamin, Emelia J.; Alonso, Alvaro.

In: Europace, Vol. 16, No. 10, 01.01.2014, p. 1426-1433.

Research output: Contribution to journalArticle

Sinner, MF, Stepas, KA, Moser, CB, Krijthe, BP, Aspelund, T, Sotoodehnia, N, Fontes, JD, Janssens, ACJW, Kronmal, RA, Magnani, JW, Witteman, JC, Chamberlain, A, 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 2014, 'B-type natriuretic peptide and C-reactive protein in the prediction of atrial fibrillation risk: The CHARGE-AF Consortium of community-based cohort studies', Europace, vol. 16, no. 10, pp. 1426-1433. https://doi.org/10.1093/europace/euu175
Sinner, Moritz F. ; Stepas, Katherine A. ; Moser, Carlee B. ; Krijthe, Bouwe P. ; Aspelund, Thor ; Sotoodehnia, Nona ; Fontes, João D. ; Janssens, A. Cecile J.W. ; Kronmal, Richard A. ; Magnani, Jared W. ; Witteman, Jacqueline C. ; Chamberlain, Alanna ; Lubitz, Steven A. ; Schnabel, Renate B. ; Vasan, Ramachandran S. ; Wang, Thomas J. ; Agarwal, Sunil K. ; McManus, David D. ; Franco, Oscar H. ; Yin, Xiaoyan ; Larson, Martin G. ; Burke, Gregory L. ; Launer, Lenore J. ; Hofman, Albert ; Levy, Daniel ; Gottdiener, John S. ; Kääb, Stefan ; Couper, David ; Harris, Tamara B. ; Astor, Brad C. ; Ballantyne, Christie M. ; Hoogeveen, Ron C. ; Arai, Andrew E. ; Soliman, Elsayed Z. ; Ellinor, Patrick T. ; Stricker, Bruno H.C. ; Gudnason, Vilmundur ; Heckbert, Susan R. ; Pencina, Michael J. ; Benjamin, Emelia J. ; Alonso, Alvaro. / B-type natriuretic peptide and C-reactive protein in the prediction of atrial fibrillation risk : The CHARGE-AF Consortium of community-based cohort studies. In: Europace. 2014 ; Vol. 16, No. 10. pp. 1426-1433.
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abstract = "Aims: 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. Methods and results: 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 [Cstatistic, 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, χ2 = 17.0; CRP, χ2 = 10.5; BNP and CRP, χ2 = 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. Conclusion: 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. Published by Oxford University Press on behalf of the European Society of Cardiology 2014.",
keywords = "Atrial fibrillation, B-type natriuretic peptide, Biomarker, C-reactive protein, Epidemiology, Risk prediction",
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TY - JOUR

T1 - B-type natriuretic peptide and C-reactive protein in the prediction of atrial fibrillation risk

T2 - The CHARGE-AF Consortium of community-based cohort studies

AU - Sinner, Moritz F.

AU - Stepas, Katherine A.

AU - Moser, Carlee B.

AU - Krijthe, Bouwe P.

AU - Aspelund, Thor

AU - Sotoodehnia, Nona

AU - Fontes, João D.

AU - Janssens, A. Cecile J.W.

AU - Kronmal, Richard A.

AU - Magnani, Jared W.

AU - Witteman, Jacqueline C.

AU - Chamberlain, Alanna

AU - Lubitz, Steven A.

AU - Schnabel, Renate B.

AU - Vasan, Ramachandran S.

AU - Wang, Thomas J.

AU - Agarwal, Sunil K.

AU - McManus, David D.

AU - Franco, Oscar H.

AU - Yin, Xiaoyan

AU - Larson, Martin G.

AU - Burke, Gregory L.

AU - Launer, Lenore J.

AU - Hofman, Albert

AU - Levy, Daniel

AU - Gottdiener, John S.

AU - Kääb, Stefan

AU - Couper, David

AU - Harris, Tamara B.

AU - Astor, Brad C.

AU - Ballantyne, Christie M.

AU - Hoogeveen, Ron C.

AU - Arai, Andrew E.

AU - Soliman, Elsayed Z.

AU - Ellinor, Patrick T.

AU - Stricker, Bruno H.C.

AU - Gudnason, Vilmundur

AU - Heckbert, Susan R.

AU - Pencina, Michael J.

AU - Benjamin, Emelia J.

AU - Alonso, Alvaro

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Aims: 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. Methods and results: 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 [Cstatistic, 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, χ2 = 17.0; CRP, χ2 = 10.5; BNP and CRP, χ2 = 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. Conclusion: 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. Published by Oxford University Press on behalf of the European Society of Cardiology 2014.

AB - Aims: 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. Methods and results: 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 [Cstatistic, 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, χ2 = 17.0; CRP, χ2 = 10.5; BNP and CRP, χ2 = 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. Conclusion: 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. Published by Oxford University Press on behalf of the European Society of Cardiology 2014.

KW - Atrial fibrillation

KW - B-type natriuretic peptide

KW - Biomarker

KW - C-reactive protein

KW - Epidemiology

KW - Risk prediction

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