Abstract

Objectives

The purpose of this study was to assess whether high-sensitivity C-reactive protein (hs-CRP), N-terminal pro-brain natriuretic peptide (NT-proBNP), and soluble urokinase plasminogen activator receptor (suPAR) differed in their ability to predict cardiovascular outcomes beyond traditional risk factors in younger and older men and women without known cardiovascular disease. Design. Prospective population-based cohort study of 1951 individuals from the MONItoring of trends and determinants in Cardiovascular disease (MONICA) study, examined 1993–1994. Participants were stratified into four groups based on sex and age. Subjects aged 41 or 51 years were classified as younger; those aged 61 or 71 years were classified as older. The principal endpoint was death from cardiovascular causes. Predictive capabilities of biomarkers were tested using Cox proportional-hazards regression, Harrell’s concordance-index, net reclassification improvement, and classification and regression tree (CART) analysis. Results. Median follow-up was 18.5 years, during which 19/597 younger men, 100/380 older men, 12/607 younger women, and 46/367 older women had died from a cardiovascular cause. NT-proBNP was independently associated with death from cardiovascular causes among all participants (p ≤ .02) except younger women (p = .70), whereas hs-CRP was associated with this endpoint in men (p ≤ .007), and suPAR in older men only (p < .001). None of the biomarkers improved discrimination ability beyond traditional risk factors (p ≥ .07). However, NT-proBNP enhanced reclassification in men and older women. CART-analysis showed that NT-proBNP was generally of greater value among men, and suPAR among women. Conclusions. Hs-CRP, NT-proBNP, and suPAR displayed different associations with cardiovascular death among apparently healthy younger and older men and women.

中文翻译：

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循环生物标志物预测能力的性别和年龄相关差异：来自 MONICA 10 队列

摘要

目标

本研究的目的是评估高敏 C 反应蛋白 (hs-CRP)、N 末端脑利钠肽前体 (NT-proBNP) 和可溶性尿激酶纤溶酶原激活物受体 (suPAR) 的能力是否不同。在没有已知心血管疾病的年轻和年长男性和女性中预测超出传统风险因素的心血管结局。设计。心血管疾病趋势和决定因素监测 (MONICA) 研究中对 1951 名个体进行的前瞻性基于人群的队列研究，检查了 1993 年至 1994 年。参与者根据性别和年龄分为四组。41 岁或 51 岁的受试者被归类为较年轻；61 岁或 71 岁的人被归类为老年人。主要终点是心血管原因死亡。使用 Cox 比例风险回归、Harrell 一致性指数、净重分类改进以及分类和回归树 (CART) 分析测试了生物标志物的预测能力。结果。中位随访时间为 18.5 年，其中 19/597 名年轻男性、100/380 名老年男性、12/607 名年轻女性和 46/367 名老年女性死于心血管疾病。NT-proBNP 与所有参与者的心血管原因死亡独立相关（p  ≤ .02），除了年轻女性（p  = .70），而 hs-CRP 与男性的这一终点相关（p  ≤ .007）和 suPAR仅在老年男性中（p  < .001）。没有一种生物标志物能提高传统风险因素之外的辨别能力（p  ≥ .07）。然而，NT-proBNP 增强了男性和老年女性的重新分类。CART 分析显示 NT-proBNP 在男性中的价值通常更高，而在女性中 suPAR 价值更高。结论。Hs-CRP、NT-proBNP 和 suPAR 在明显健康的年轻和年长男性和女性中显示出与心血管死亡不同的关联。