B-Type Natriuretic Peptides and Cardiovascular Risk

Abstract

Background-Measurement of B-type natriuretic peptide (BNP) concentration or its precursor (N-terminal fragment [NT-proBNP]) is recommended in patients with symptoms of left ventricular dysfunction and in other settings, but the relevance of these peptides to cardiovascular disease (CVD) in general populations or in patients with stable vascular disease is uncertain. Methods and Results-Data were collated from 40 long-term prospective studies involving a total of 87 474 participants and 10 625 incident CVD outcomes. In a comparison of individuals in the top third with those in the bottom third of baseline values of natriuretic peptides, the combined risk ratio (RR), adjusted for several conventional risk factors, was 2.82 (95% confidence interval [CI], 2.40 to 3.33) for CVD. Analysis of the 6 studies with at least 250 CVD outcomes (which should be less prone to selective reporting than are smaller studies) yielded an adjusted RR of 1. Key Words: cardiovascular diseases Ⅲ meta-analysis Ⅲ natriuretic peptides B -type natriuretic peptide (BNP) is a 32-amino acid polypeptide secreted by ventricular myocytes during periods of increased ventricular stretch and wall tension. This peptide is believed to play an important role in the regulation of blood pressure, blood volume, and sodium balance. On secretion, the BNP precursor is split into the biologically active peptide and the more stable N-terminal fragment (NT-proBNP). 1,2 Measurement of circulating levels of BNP or NT-proBNP has been recommended in the diagnosis and prognosis of patients with symptoms of left ventricular dysfunction 3 and for stratification of risk in patients with acute coronary syndromes. 4,5 Because in vitro studies have reported that natriuretic peptides are directly released from cardiomyocytes in response to myocardial ischemia, 6,7 it has been proposed that their circulating levels are relevant to subsequent risk of cardiovascular diseases (CVDs) other than heart failure. Clinical Perspective on p 2187Although many prospective studies have investigated concentrations of natriuretic peptides in relation to the subsequent risk of CVD (eg, coronary heart disease [CHD] or stroke), most of them have not been systematically assessed. 8 -47 Two previous relevant reviews (in total involving 11 studies 48,49 ) involved only about one sixth of the currently available data. Interpretation of the evidence has been complicated by studies that have involved different markers (ie, BNP, NT-proBNP, or both), populations with different base- We report an updated meta-analysis of findings from 40 long-term prospective studies of BNP and NT-proBNP involving a total of 87 474 individuals, including 10 625 incident CVD outcomes, in 3 distinct groups: participants from approximately general populations, people selected on the basis of elevated CVD risk factors, and patients with stable CVD at study entry. Methods Study SelectionWe sought prospective studies that had been published before July 2009 and reported on associations of circulating BNP and/or NTproBNP w...

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“…The overall adjusted risk ratio for the top third compared with the bottom third of NT‐proBNP found in that study was 1.94 (95% CI 1.57–2.39) and is of comparable magnitude to our results. Increments in c‐statistics after adding NT‐proBNP to conventional risk scores ranged from 0.01 to 0.10 in a variety of populations including patients with elevated CVE risk factors and stable cardiovascular disease at baseline, also in line with the present findings 9, 24. Further, the addition of NT‐proBNP resulted in an NRI of 0.198 in a large general population study, whereas the NRI increased to 0.386 in a sample of diabetic patients from the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial 25, 26.…”

“…NT‐proBNP is a polypeptide secreted by cardiomyocytes in response to increased ventricular stretch and wall tension. A recent meta‐analysis summarized the incremental predictive value of measuring NT‐proBNP in other populations 9. The overall adjusted risk ratio for the top third compared with the bottom third of NT‐proBNP found in that study was 1.94 (95% CI 1.57–2.39) and is of comparable magnitude to our results.…”

“…To enhance predictive performance novel markers conveying information on underlying atherosclerotic disease progression could be helpful. Recent studies in mostly healthy populations have suggested a number of biomarkers that might improve CVE risk prediction 8, 9, 10. These include markers of several pathophysiological pathways, such as measures of inflammation, coagulation, collagen degradation, angiogenesis, metabolic regulation, and adipocyte function.…”

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“…Although a reduction in cardiovascular morbidity and mortality has been a major goal of therapy in patients with T2DM, therapeutic strategies focused on intensive glycemic control in these patients have largely failed to show a substantial impact on cardiovascular morbidity and mortality, at least in the short term 5, 6, 7, 8. Circulating concentrations of cardiac troponin, a marker of myocardial injury, and natriuretic peptides (NPs), markers of myocardial stress, have emerged as powerful predictors of cardiovascular risk in stable patients with and without T2DM 9, 10, 11, 12, 13. Both markers have also been associated with abnormalities in glucose metabolism.…”

Impacto de los niveles plasmáticos de pro-péptido natriurético tipo B aminoterminal, proteína quimiotáctica de monocitos-1 y galectina3 en la capacidad predictiva de eventos de la escala clínica LIPID en la enfermedad coronaria estable

“…Recientemente hemos demostrado que los niveles plasmáticos de la proteína quimiotáctica de monocitos 1 (MCP-1), galectina-3 (Gal-3) y pro-péptido natriurético tipo B aminoterminal (NT-ProBNP) predicen el desarrollo de eventos adversos en pacientes con cardiopatía isquémica (CI) estable 10 . Se trata de un conjunto de biomarcadores relacionados fundamentalmente con la inflamación 11,12 , la fibrosis, el remodelado miocárdico 13 y la insuficiencia cardiaca [14][15][16] .…”