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July 20, 2005

Biomarkers for Mortality and Cardiovascular Events—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;294(3):303-304. doi:10.1001/jama.294.3.303-b

In Reply: Dr Koenig states that a potential high prevalence of diastolic dysfunction in our older population might favor NT-proBNP as a risk marker compared with CRP and urinary albumin/creatinine ratio. We found that NT-proBNP predicted development of heart failure and, as noted in our article, this finding may in part be explained by the presence of undetected diastolic dysfunction. We agree that the predictive value of biomarkers in the general population should be investigated in individuals without apparent cardiovascular disease. Accordingly, participants with prevalent ischemic heart disease and previous ischemic stroke were excluded from the analyses of major cardiovascular events. Our finding that NT-proBNP is also a strong predictor in these individuals without cardiovascular disease is consistent with data from the Framingham Heart Study, which investigated BNP as a risk marker in a younger community-based cohort.1