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To the Editor: Dr Ridker and colleagues¹ assessed 35 blood-based biomarkers and traditional epidemiological risk factors to develop a new risk algorithm. It appears that no natriuretic peptide was tested for inclusion in this model. Natriuretic peptides have been shown to predict cardiovascular outcomes in multiple populations, including men and women in the general population and older adults.^2-5 It would be of interest to see how the addition of either B-type natriuretic peptide or amino-terminal pro-B-type natriuretic peptide might affect their proposed models for cardiovascular risk assessment in women.

Financial Disclosures: None reported.

Lori B. Daniels, MD
loridaniels@ucsd.edu
University of California
San Diego

Ori Ben-Yehuda, MD
University of California
San Diego

Alan S. Maisel, MD
Veterans Affairs San Diego Healthcare System
San Diego, California

1. Ridker PM, Buring JE, Rifai N, Cook N. Development and validation of improved algorithms for the assessment of global cardiovascular risk in women. JAMA. 2007;297(6):611-619. FREE FULL TEXT 2. Wang TJ, Larson MG, Levy D, et al. Plasma natriuretic peptide levels and the risk of cardiovascular events and death. N Engl J Med. 2004;350(7):655-663. FREE FULL TEXT 3. Laukkanen JA, Kurl S, Ala-Kopsala M, et al. Plasma N-terminal fragments of natriuretic propeptides predict the risk of cardiovascular events and mortality in middle-aged men. Eur Heart J. 2006;27(10):1230-1237. FREE FULL TEXT 4. Kistorp C, Raymond I, Pedersen F, Gustafsson F, Faber J, Hildebrandt P. N-terminal pro-brain natriuretic peptide, C-reactive protein, and urinary albumin levels as predictors of mortality and cardiovascular events in older adults. JAMA. 2005;293(13):1609-1616. FREE FULL TEXT 5. Wang TJ, Gona P, Larson MG, et al. Multiple biomarkers for the prediction of first major cardiovascular events and death. N Engl J Med. 2006;355(25):2631-2639. FREE FULL TEXT

JAMA. 2007;298:177.

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