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Urine Albumin/Creatinine Ratio, High Sensitivity C-Reactive Protein and N-Terminal Pro Brain Natriuretic Peptide - Three New Cardiovascular Risk Markers - Do They Improve Risk Prediction and Influence Treatment?

[ Vol. 8 , Issue. 1 ]

Author(s):

Michael H. Olsen, Thomas Sehestedt, Stig Lyngbaek, Tine W. Hansen, Susanne Rasmussen, Kristian Wachtell, Christian Torp-Pedersen, Per R. Hildebrandt and Hans Ibsen   Pages 134 - 139 ( 6 )

Abstract:


In order to prioritize limited health resources in a time of increasing demands optimal cardiovascular risk stratification is essential. We tested the additive prognostic value of 3 relatively new, but established cardiovascular risk markers: N-terminal pro brain natriuretic peptide (Nt-proBNP), related to hemodynamic cardiovascular risk factors, high sensitivity C-reactive protein (hsCRP), related to metabolic cardiovascular risk factors and urine albumin/creatinine ratio (UACR), related to hemodynamic as well as metabolic risk factors. In healthy subjects with a 10-year risk of cardiovascular death lower than 5% based on HeartScore and therefore not eligible for primary prevention, the actual 10-year risk of cardiovascular death exceeded 5% in a small subgroup of subjects with UACR higher than the 95-percentile of approximately 1.6 mg/mmol. Combined use of high UACR or high hsCRP identified a larger subgroup of 16% with high cardiovascular risk in which primary prevention may be advised despite low-moderate cardiovascular risk based on HeartScore. Furthermore, combined use of high UACR or high Nt-proBNP in subjects with known cardiovascular disease or diabetes identified a large subgroup of 48% with extremely high cardiovascular risk who should be referred for specialist care to optimize treatment.

Keywords:

Urine albumin/creatinine ratio, high sensitivity C-reactive protein, N-terminal pro brain natriuretic peptide, risk stratification, prognosis, general population

Affiliation:

Cardiovascular Research Unit, Cardiology Section, Department of Internal Medicine, Glostrup University Hospital, 2600 Glostrup, Denmark.



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