Dr. Michael Fulks discusses a new study that confirms NT-proBNP and other cardiovascular biomarkers improve prediction of cardiac events and mortality, especially in older adults.
We previously published on the value of adding NT-proBNP testing in predicting all-cause mortality and found it to be very effective for life insurance applicants where it is now commonly used at older ages and higher face amounts. In addition, we looked at adding high-sensitivity troponin but lacked sufficient data to determine its additional value in prediction of all-cause mortality in an apparently well population such as life insurance applicants.
A new paper in JAMA authored by JT Neumann, et al. more broadly explores the potential value of adding cardiovascular biomarkers including high sensitivity-troponin I or T, NT-proBNP, BNP, and high-sensitivity C-reactive protein (hs CRP) to conventional history, exam and lab tests in predicting new cardiac event and all-cause mortality in an average risk population. They combined 28 cohorts, mainly in the US and Europe, where conventional risk factor information was also available (BP, BMI, lipids, smoking, DM, etc.) to create a large study population with 10 years of follow-up.
The study found that NT-proBNP, hs CRP and hs troponin T or I all independently improved the prediction of atherosclerotic events and death (including MI, heart failure and all-cause mortality) at the 1-, 5- and 10-year mark and were additive. NT-proBNP was the most predictive single biomarker for all but MI where hs CRP was the winner.
Biomarker prediction was better for mortality and heart failure than it was for acute CV events where the additional predictive value was small. It was also better at age 65+ than at younger ages where the traditional markers had a larger impact on risk reducing any additional impact from biomarkers.
This study provides additional confirmation of our earlier results in insurance applicants and CRL’s decision to focus on NT-proBNP as the biomarker to add first and suggesting beginning use at ages 50+ or 65+.
About the Author
Michael Fulks, MD, Consulting Medical Director, is board-certified in internal and insurance medicine. After leaving practice, he served as a medical director, creating or editing several underwriting manuals and preferred programs. More recently, Mike has consulted for CRL participating in its mortality research on laboratory test results, BP and build, and in the development of risk-scoring tools for laboratory and non-laboratory data.