Differential associations of cardiorenal-inflammatory markers with incident cardiovascular disease and cancer in the general population
Y Yang, T F Kok, M Maronier, B van der Vegt, K Damman, R T Gansevoort, S J L Bakker, R A de Boer, W C Meijers, N SuthaharAbstract
Background and Purpose
Elevated levels of cardiorenal-inflammatory markers reflect not only risk of cardiovascular disease (CVD), but also of cancer. The objectives of the current study were to examine whether N-terminal pro-B-type natriuretic peptide (NT-proBNP), urinary albumin excretion (UAE) and high-sensitivity C reactive protein (hsCRP) differentially associate with incident CVD and cancer in the general population, and to assess whether these associations vary by follow-up duration.
Methods
We prospectively followed 7755 participants from the Prevention of REnal and Vascular End-stage Disease (PREVEND) study who were free of cancer and CVD at baseline. All three biomarkers were log-transformed and standardized prior to analyses. Associations of biomarkers with incident outcome were assessed using Cox proportional hazards models adjusting for age, sex and clinical risk factors. CVD included fatal and nonfatal cardiovascular, cerebrovascular, and peripheral vascular events. Cancer included all malignancies except nonmelanoma skin cancers. For cancer incidence, data were retrieved via linkage to the Dutch Nationwide Pathology Databank (Palga).
Results
Mean age was 48.9±12.4 years and 3980 (51.3%) were women. Over 12 years of follow-up, 740 (9.5%) participants developed CVD and 662 (8.5%) developed cancer. Whereas NT-proBNP, UAE, and hsCRP were significantly associated with incident CVD, only hsCRP was significantly associated with incident cancer. When formally compared, NT-proBNP and hsCRP were more strongly associated with incident CVD than incident cancer (Pdifference=0.001 for both), while UAE was similarly associated with both outcomes (Pdifference=0.362). In secondary analyses restricted to the first 5 years of follow-up, 294 (3.8%) developed CVD and 212 (2.7%) developed cancer, and all three biomarkers were significantly associated with both outcomes. When formally compared, hsCRP remained more strongly associated with incident CVD than cancer (Pdifference=0.005), whereas NT-proBNP and UAE showed comparable associations with both outcomes (Pdifference=0.297 and 0.236, respectively).
Conclusions
In the general population, hsCRP is more strongly associated with incident CVD than cancer. NT-proBNP and albuminuria are consistently associated with incident CVD, and their stronger associations with incident cancer over short-term follow-up warrant further investigation.Forrest Plot