N-terminal-proB-type natriuretic peptide predicts cardiovascular disease events in HIV-infected patients

Duprez, Daniel; Neuhaus, Jacqueline; Tracy, Russell P.; Kuller, Lewis H.; Deeks, Steven G.; Orkin, Chloe; Stoehr, Albrecht; Woolley, Ian; Neaton, James D.

doi:10.1097/qad.0b013e32834404a1

Cited by 30 publications

(20 citation statements)

References 29 publications

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“…The biomarkers included: ST2 (fibrosis); GDF-15 (apoptosis); NT-proBNP (myocyte stretch); hsTnI (myocardial injury); hsCRP and IL-6 (inflammation); Cystatin C (renal dysfunction); and D-dimer (thrombosis). (4, 5, 9–12) Thresholds of risk for ST2, GDF-15, and NT-proBNP were pre-defined based on prior studies associating values exceeding these cut-points with CVD. These thresholds were: ST2 >35 ng/ml, GDF-15 >1200 pg/ml, and NT-proBNP >300 pg/ml.…”

Section: Methodsmentioning

confidence: 99%

Novel Biomarkers of Cardiac Stress, Cardiovascular Dysfunction, and Outcomes in HIV-Infected Individuals

Secemsky

Scherzer

Nitta

et al. 2015

JACC: Heart Failure

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Objectives We sought to determine whether biomarkers ST2, GDF-15, NT-proBNP, and high-sensitivity Troponin I are elevated in HIV-infected patients and associated with cardiovascular dysfunction and all-cause mortality. Background HIV-infected individuals have high rates of cardiovascular disease. Markers of myocardial stress may identify at-risk patients and provide additional prognostic information. Methods Biomarkers and echocardiograms were assessed in 332 HIV-infected patients and 50 age- and gender-matched controls. Left ventricular systolic dysfunction (LVSD) was defined as ejection fraction <50%, diastolic dysfunction (DD) as ≥stage 1, and pulmonary hypertension as PASP ≥35mmHg. Mortality data was obtained from the National Death Index. Results HIV patients were a median 49 years and 80% male. Compared with controls, HIV patients had higher percent estimates of all biomarkers except ST2 and interleukin-6. Among HIV patients, 45% had DD; only ST2 was associated with DD (RR 1.36, p=0.047). LVSD was rare in this cohort (5%). Pulmonary hypertension was present in 27% of HIV patients and associated with GDF-15 (RR 1.18, p=0.04), NT-proBNP (RR 1.18, p=0.007), and Cystatin C (RR 1.54, p=0.03). Thirty-eight deaths occurred among HIV subjects over a median 6.1 years. In adjusted analysis, all-cause mortality was independently predicted by ST2 (HR 2.04, p=0.010), GDF-15 (HR 1.42, p=0.0054), hsCRP (HR 1.25, p=0.023) and D-dimer (HR 1.49, p=0.029). Relationships were unchanged when analyses were restricted to virally-suppressed HIV-infected patients on antiretroviral therapy. Conclusions Among HIV-infected individuals, ST2 and GDF-15 are associated with both cardiovascular dysfunction and all-cause mortality and may be useful at identifying those at-risk for developing cardiovascular events and death.

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Section: Methodsmentioning

confidence: 99%

Novel Biomarkers of Cardiac Stress, Cardiovascular Dysfunction, and Outcomes in HIV-Infected Individuals

Secemsky

Scherzer

Nitta

et al. 2015

JACC: Heart Failure

View full text Add to dashboard Cite

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“…In the present study, measurements were not conducted specifically to detect subclinical vascular disease, but studies such as the one mentioned advocate the use of NTproBNP as a surrogate marker of vascular disease. Duprez et al [14] reported a higher risk of cardiovascular events among patients with HIV infection and higher levels of NT-proBNP than among those with lower levels. This relationship was controlled using traditional cardiovascular risk factors and other biomarkers such as highly sensitive C-reactive protein and D-dimer.…”

Section: Discussionmentioning

confidence: 99%

“…It is considered a risk marker of vascular events in the general population [13] and also in patients with HIV infection [14].…”

Section: Introductionmentioning

confidence: 99%

Factors related to NT-proBNP levels in HIV patients aged over 40 years

et al. 2015

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Objective: To determine the levels of NT-pro BNP in HIV patients over 40 years who are receiving highly active antiretroviral therapy (HAART) and investigating potential independent clinical or laboratory factors. Method: We determine levels of NT-pro BNP in peripheral blood of HIV patients from Costa del Sol Hospital, over 40 years. We collected epidemiological, classical cardiovascular risk factors and variables associated with HIV infection status. The qualitative variables were compared using the χ2 test. NT-proBNP levels were taken as the dependent variable. The association between these levels and the quantitative variables were studied by analysis of variance (ANOVA), and the association with the qualitative variables, using Student's t test. Results: Nt-pro BNP levels were determined in 146 HIV patients. We assess the 10-year cardiovascular risk calculated by the Framingham equation, 59 (41.5%) were classified as low risk, 46 (32.4%) as a moderate risk and 37 (26.1%) as a high risk. The higher levels of NT-pro BNP were found in women, and in those patient with lower filtration rate and high levels of triglycerides. An association was also observed between higher levels of NT-proBNP and the recent use of lamivudine and fosamprenavir. After a multivariate analysis we found an association between higher levels of NT-proBNP and the current use of fosamprenavir and a lower glomerular filtration rate. Conclusions: We found, with the limitations of a small serie, that higher levels of NTproBNP in HIV patients could be linked to the occurrence of cardiovascular events, this fact suggest that NTpro BNP could be used in patients at moderate or high vascular risk in order to optimise the primary prevention of vascular events.

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“…Their role in predicting CVD in the HIV-infected population remains unclear [81,83]. Several other biomarkers are currently being evaluated (e.g., markers of thrombotic activity such as d-dimer and fibrinogen, as well as NT-proBNP, which showed an independent association with CVD in an HIV-infected population) [84][85][86]. A biomarker that is new to HIV is sCD163, which has recently been shown to decrease to normal levels after initiation of cART in patients with early HIV, but remains elevated in chronic HIV [87]; results that correspond well to previous endothelial biomarker findings made by others [12].…”

Section: Biomarkers Of Early Atherosclerosismentioning

confidence: 98%

Cardiovascular Disease in Patients with HIV

et al. 2012

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The introduction of combination antiretroviral therapy (cART) has substantially decreased mortality among the HIV-infected population. In this setting, cardiovascular disease (CVD) has become a leading cause of morbidity and mortality. Compared with the general population, higher rates of myocardial infarction as well as a high prevalence of subclinical coronary atherosclerosis have been found in the HIV-infected population. It has been suggested that in HIV-infected patients, the atherosclerotic burden is not based solely on traditional cardiovascular risk factors. The interplay of other mechanisms such as chronic inflammation, effects of cART or immune activation after initiation of cART may predispose to accelerated and increased risk of CVD. Effective treatment are available today to reduce CVD in at-risk patients, and therefore early detection of subclinical coronary atherosclerosis is important. However, the mechanisms behind the development of CVD in HIV-infected patients may limit the usefulness of the traditional noninvasive screening tools for CVD used in the general population. This review will focus on the different plausible mechanisms behind the increased risk of CVD and the noninvasive methods by which atherosclerosis may be assessed in the HIV-infected population.

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N-terminal-proB-type natriuretic peptide predicts cardiovascular disease events in HIV-infected patients

Cited by 30 publications

References 29 publications

Novel Biomarkers of Cardiac Stress, Cardiovascular Dysfunction, and Outcomes in HIV-Infected Individuals

Novel Biomarkers of Cardiac Stress, Cardiovascular Dysfunction, and Outcomes in HIV-Infected Individuals

Factors related to NT-proBNP levels in HIV patients aged over 40 years

Cardiovascular Disease in Patients with HIV

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