B‐type Natriuretic Peptides in Acute Coronary Syndromes: Implications in an Aging Population

Abstract

B-type natriuretic peptide (BNP) and N-terminal-proBNP (NT-proBNP) are increasingly recognized as prognostic markers in patients with acute coronary syndrome (ACS). The need for novel and more effective tools for risk assessment cannot be more emphasized than in older patients with ACS given their atypical presentation, multiple comorbidities, and higher risk for mortality and morbidity. Accurate interpretation of B-type NP values in older patients with ACS, however, may be confounded by several aging-related physiologic changes. Advanced age, reduction in body mass, and kidney function and anemia have been associated with higher BNP and NT-proBNP concentrations, and may create challenges with interpreting NP levels in the elderly. This review highlights the need to better understand the physiology of BNP and NT-proBNP in older individuals and their prognostic value in older patients with ACS. IntroductionThe prognostic role of B-type natriuretic peptide (BNP) and N-terminal-proBNP (NT-proBNP) in acute coronary syndromes (ACS) remains the subject of vigorous investigation reflecting the growing interest in improving risk stratification strategies for affected patients. While a compelling body of evidence demonstrates that these biomarkers independently predict adverse outcomes, a few issues of uncertainty limit their routine use in clinical decision making. One is the question of whether existing evidence can be extrapolated to the older population. This is an important issue as approximately 82% of deaths from coronary artery disease (CAD) occur in individuals age 65 or older. 1 Fundamental to examining the value of BNP and NT-proBNP in older persons with CAD is identifying aging-related factors that may influence their levels. This review summarizes current literature describing the value of these biomarkers in older patients with ACS. The relationship of BNP and NT-proBNP with advanced age and its associated physiologic alterations is also reviewed.

The influence of age on the clinical implications of N-terminal pro-B-type natriuretic peptide in acute coronary syndrome

“…As elderly ACS patients often present with atypical symptoms, non-diagnostic electrocardiograms and more comorbidities, traditional risk stratification in elderly ACS patients is generally more difficult than that in younger patients [4,20]. Consistent data from our study show that the C-index of TIMI risk score, in which patients' symptoms and electrocardiograms are incorporated into the calculation, drops from 0.70 in the 1st age group to 0.60 in the 3rd group.…”

“…Age has a major impact on the concentrations of NTproBNP due to some age-related factors [4] (e.g., increased fibrosis and cardiac stiffness, diminished renal function, decreased lean body mass), with elevated NT-proBNP levels in advanced age groups being frequently observed even in apparently healthy subjects. Therefore, elevated NT-proBNP levels in younger patients might be a more serious indication, and may be irrelevant with the elderly.…”

Aging in cats

“…increased NT-proBNP levels in older human patients are confounded by several aging-related physiologic changes, including reduction in body mass and kidney function, and anemia. 89 Thus, until the effect of aging on NT-proBNP in feline patients is specifically studied, interpretation of this test may be challenging in the geriatric cat population.…”

Association between N-terminal proB-type Natriuretic Peptide and Depressive Symptoms in Patients with Acute Myocardial Infarction

“…This biological marker has been identified as a vital predictor of mortality and subsequent myocardial infarction (MI) in patients with AMI. [ 6 7 8 9 ] Prior evidence indicated that patients with major depressive disorder (MDD) had increased NT-proBNP levels,[ 10 ] and results from several surveys suggested that NT-proBNP levels were correlated with depressive symptoms in patients with cardiovascular diseases. [ 11 12 ] However, the above findings are not conclusive, with some studies failing to find a statistically significant association between NT-proBNP levels and depression.…”