Journal Article

NT-proBNP Predicts Cardiovascular Death in the General Population Independent of Left Ventricular Mass and Function: Insights from a Large Population-Based Study with Long-Term Follow-Up

Heid, Iris M., Meisinger, Christa, Stark, Klaus, Zimmermann, Martina E., Maier, Lars S., Schunkert, Heribert, Luchner, Andreas, Dietl, Alexander, Birner, Christoph, Peters, Annette

2016

Overview

B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) predict cardiovascular endpoints in patients and all-cause death in the general population. This was assigned to their association with clinical cardiac remodelling defined as changes in size, shape and function of the heart. The aim of this study was to evaluate whether NT-proBNP and BNP were associated with cardiovascular and overall death independent of clinical cardiac remodelling measured by echocardiography as left ventricular hypertrophy (LVH), diastolic dysfunction and left ventricular ejection fraction (EF). In a general population-based cohort study from Germany (KORA-S3) with subjects' baseline age ranging from 25 to 74 years, cardiac morphology and function were assessed as left ventricular mass (LVM), diastolic dysfunction and EF by echocardiography and circulating NT-proBNP and BNP were measured at baseline. In 1,223 subjects with mortality follow-up information, we examined the association of baseline NT-proBNP and BNP with cardiovascular mortality (number of deaths = 52, median follow-up time = 12.9years) using Cox regression without and with adjustment for cardiovascular risk factors, LVM, diastolic dysfunction and EF. The risk of cardiovascular mortality increased with higher NT-proBNP levels measured at baseline (hazard ratio HR = 1.67 per unit increment in logNT-proBNP, p = 2.78*10-4, adjusted for age and sex). This increased risk persisted after adjustment for cardiovascular risk factors, LVM, diastolic dysfunction and EF (HR = 1.73; p = 0.047). When excluding subjects with relevant LVH (LVM to body surface area > 149g/m2 in men / 122g/m2 in women), the NT-proBNP association with mortality was still significant (n = 1,138; number of deaths = 35; HR = 1.48; p = 0.04). We found similar results for BNP. Our data confirms NT-proBNP and BNP as predictor of cardiovascular mortality in a large general population-based study with long-term follow-up. Our study extends previously published population-based studies to younger and potentially healthier individuals without relevant LVH, diastolic dysfunction or LVD.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Atherosclerosis / Biology and Life Sciences / Biomarkers / Blood pressure / Brain natriuretic peptide / Brain research / Cardiac patients / Cardiovascular diseases / Consent / Death / Diabetes / Echocardiography / Environmental health / Epidemiology / Fatalities / Female / Follow-Up Studies / Health risks / Heart / Heart diseases / Heart failure / Heart hypertrophy / Heart Ventricles - anatomy & histology / Heart Ventricles - pathology / Hospitals / Humans / Hypertension / Hypertrophy / Hypertrophy, Left Ventricular - blood / Hypertrophy, Left Ventricular - mortality / Hypertrophy, Left Ventricular - pathology / Hypertrophy, Left Ventricular - physiopathology / Internal medicine / Male / Medical research / Medicine / Medicine and Health Sciences / Mens health / Middle age / Middle Aged / Morphology / Mortality / Natriuretic Peptide, Brain - blood / Natriuretic peptides / Obesity / Older people / Organ Size / People and Places / Peptide Fragments - blood / Peptides / Population / Population studies / Population-based studies / Remodeling / Research and Analysis Methods / Risk analysis / Risk factors / Studies / Surface area / Ventricle / Ventricular Function, Left