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Cardiac risk scores in high-risk Hispanics and the predictive value of BNP

Authors

  • Aurelia Macabasco-O’Connell,

    1. Authors:Aurelia Macabasco-O’Connell, PhD, RN, ACNP, Assistant Professor, University of California Los Angeles School of Nursing, Los Angeles, CA; Sara Danwalder, RN, BSN, Registered Nurse, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA; Karabi Sinha, PhD, Biostatistician, University of California Los Angeles School of Public Health and School of Nursing, Los Angeles, CA, USA
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  • Sara Danwalder,

    1. Authors:Aurelia Macabasco-O’Connell, PhD, RN, ACNP, Assistant Professor, University of California Los Angeles School of Nursing, Los Angeles, CA; Sara Danwalder, RN, BSN, Registered Nurse, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA; Karabi Sinha, PhD, Biostatistician, University of California Los Angeles School of Public Health and School of Nursing, Los Angeles, CA, USA
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  • Karabi Sinha

    1. Authors:Aurelia Macabasco-O’Connell, PhD, RN, ACNP, Assistant Professor, University of California Los Angeles School of Nursing, Los Angeles, CA; Sara Danwalder, RN, BSN, Registered Nurse, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA; Karabi Sinha, PhD, Biostatistician, University of California Los Angeles School of Public Health and School of Nursing, Los Angeles, CA, USA
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Aurelia Macabasco-O’Connell, Assistant Professor, University of California Los Angeles School of Nursing, 700 Tiverton Ave., 4-242 Factor Bldg., Los Angeles, CA 90095, USA. Telephone: (310) 794 4338.
E-mail:aoconnel@sonnet.ucla.edu

Abstract

Aims.  The purpose of this study was to calculate cardiac risk scores in Hispanic subjects and to determine the predictive value of adding B-type natriuretic peptide in identifying those with asymptomatic left ventricular dysfunction as a measure of cardiovascular disease.

Background.  Hispanics have higher rates of cardiovascular risk factors leading to coronary heart disease, asymptomatic left ventricular dysfunction and cardiovascular events. Assessing cardiac risk in these groups is important to identify those at high risk for future cardiovascular events. The use of biomarkers such as B-type natriuretic peptide may increase the accuracy of risk prediction.

Design.  This study used a descriptive, cross-sectional study design to determine the utility of the standard risk assessment tools (Adult Treatment Panel III and the Framingham Risk Scores risk calculator) and the B-type natriuretic peptide biomarker to estimate coronary heart disease risk in low-income, Hispanic participants.

Methods.  A sample of 71 patients (age 52 SD 11, 69% female) with multiple cardiovascular risk factors seen at an ambulatory clinic at a county facility was enrolled in the study. Sociodemographic and medical history information were obtained. Two widely used risk calculators (Adult Treatment Panel III and Framingham Risk Scores) were used to estimate 10-year coronary heart disease risk in each subject. Baseline B-type natriuretic peptide measurement and echocardiography were performed with each subject to evaluate presence of asymptomatic left ventricular dysfunction. Receiver operating curve analyses were performed to compare predictability, sensitivity and specificity of the traditional risk scores against the B-type natriuretic peptide level to detect asymptomatic left ventricular dysfunction.

Results.  Overall mean risk scores were 5% (SD 5%) (Adult Treatment Panel III) and 10% (SD 7%) (Framingham Risk Scores). Mean B-type natriuretic peptide levels were 108·5 (SD 191·5) pg/ml. Echocardiogram results revealed a high proportion of subjects with asymptomatic left ventricular dysfunction (74·6%). The receiver operating curves showed an area under the curve of 0·67 for B-type natriuretic peptide (p < 0·05), 0·64 (p = NS) for Adult Treatment Panel III and 0·56 (p = NS) for Framingham Risk Scores, evidence that B-type natriuretic peptide does significantly better than Adult Treatment Panel or Framingham Risk Scores in predicting asymptomatic left ventricular dysfunction.

Conclusion.  The inclusion of B-type natriuretic peptide with traditional risk scores may be helpful in predicting risk and asymptomatic left ventricular dysfunction in high-risk Hispanics.

Relevance to clinical practice.  Cardiac risk scores can assist clinicians in identifying patients at high risk for developing coronary heart disease.

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