alexa C-reactive protein and B-type natriuretic peptide yield either a non-significant or a modest incremental value to traditional risk factors in predicting long-term overall mortality in older adults.
Clinical Sciences

Clinical Sciences

Cardiovascular Pharmacology: Open Access

Author(s): Beleigoli AM, Boersma E, Diniz Mde F, Vidigal PG, LimaCosta MF, , Beleigoli AM, Boersma E, Diniz Mde F, Vidigal PG, LimaCosta MF,

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Abstract BACKGROUND: New biomarkers may aid in preventive and end-of-life decisions in older adults if they enhance the prognostic ability of traditional risk factors. We investigated whether C-reactive protein (CRP) and/or B-type natriuretic peptide (BNP) improve the ability to predict overall mortality among the elderly of the Bambuí, Brazil Study of Aging when added to traditional risk factors. METHODS: From 1997 to 2007, 1,470 community-dwelling individuals (≥60 years) were followed-up. Death was ascertained by continuous verification of death certificates. We calculated hazard ratios per 1 standard deviation change (HR) of death for traditional risk factors only (old model), and traditional risk factors plus CRP and/or BNP (new models) and assessed calibration of the models. Subsequently, we compared c-statistic of each of the new models to the old one, and calculated integrated discriminative improvement (IDI) and net reclassification improvement (NRI). RESULTS: 544 (37.0\%) participants died in a mean follow-up time of 9.0 years. CRP (HR 1.28, 95\% CI 1.17-1.40), BNP (HR 1.31 95\% CI 1.19-1.45), and CRP plus BNP (HR 1.26, 95\% CI 1.15-1.38, and HR 1.29, 95\% CI 1.16-1.42, respectively) were independent determinants of mortality. All models were well-calibrated. Discrimination was similar among the old (c-statistic 0.78 [0.78-0.81]) and new models (p=0.43 for CRP; p=0.57 for BNP; and p=0.31 for CRP plus BNP). Compared to the old model, CRP, BNP, and CRP plus BNP models led to an IDI of 0.009 (p<0.001), -0.005 (p<0.001) and -0.003 (p=0.84), and a NRI of 0.04 (p=0.24), 0.07 (p=0.08) and 0.06 (p=0.10), respectively. CONCLUSIONS: Despite being independent predictors of long-term risk of death, compared to traditional risk factors CRP and/or BNP led to either a modest or non-significant improvement in the ability of predicting all-cause mortality in older adults.
This article was published in PLoS One and referenced in Cardiovascular Pharmacology: Open Access

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