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?

Michael   H.   Olsen; Thomas      Sehestedt; Stig      Lyngbaek; Tine   W.   Hansen; Susanne      Rasmussen; Kristian      Wachtell; Christian      Torp-Pedersen; Per   R.   Hildebrandt; Hans      Ibsen

doi:10.2174/157016110790226633

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

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