Article

BACKGROUND: To date, no validated risk scores exist for prediction of recurrence
risk or potential treatment effect for older people with a history of a cardiovascular event. Therefore, we assessed predictive values for recurrent
cardiovascular disease of models with age and sex, traditional cardiovascular
risk markers, and 'SMART risk score', all with and without addition of N-terminal
pro-B-type natriuretic peptide (NT-proBNP).
Treatment effect of pravastatin was assessed across low and high risk groups identified by the best performing models.
DESIGN AND METHODS: Post-hoc analysis in 2348 participants (age 70-82
years) with a history of cardiovascular disease within the PROspective Study of
Pravastatin in the Elderly at Risk (PROSPER) study. Composite endpoint was a
recurrent cardiovascular event/cardiovascular mortality. RESULTS: The models with
age and sex, traditional risk markers and SMART risk score had comparable
predictive values (area under the curve (AUC) 0.58, 0.61 and 0.59, respectively).
Addition of NT-proBNP to these models improved AUCs with 0.07 (p for difference
((pdiff)) = 0.003), 0.05 (pdiff = 0.009) and 0.06 (pdiff < 0.001), respectively.
For the model with age, sex and NT-proBNP, the hazard ratio for the composite
endpoint in pravastatin users compared with placebo was 0.67 (95% confidence
interval 0.49-0.90) for those in the highest third of predicted risk and 0.91
(0.57-1.46) in the lowest third, number needed to treat 12 and 115 (pdiff =
0.038) respectively. CONCLUSION: In secondary cardiovascular prevention in old
age addition of NT-proBNP improves prediction of recurrent cardiovascular
disease, cardiovascular mortality and treatment effect of pravastatin. A minimal
model including age, sex and NT-proBNP predicts as accurately as complex risk
models including NT-proBNP.
CI - (c) The European Society of Cardiology 2015.

Langue : ANGLAIS