Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 55, Issue 19, Pages 2140-2147Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2010.01.031
Keywords
natriuretic peptide; predictive; mortality; heart failure; myocardial infarction; cerebrovascular accident
Categories
Funding
- National Institutes of Health [RO1 HL36634, R01-HL55502, RO1 HL76611]
- Stanley J. Sarnoff Endowment for Cardiovascular Science
- Mayo Division of Cardiology
- Doris Duke Charitable Foundation [CSDA 2006064]
- M.I.U.R. Progetto Rientro dei Cervelli
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Objectives Our objective was to determine the prognostic value of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) for death and cardiovascular events among subjects without risk factors for heart failure (HF), which we term healthy normal. Background Previous studies report that plasma NT-proBNP has prognostic value for cardiovascular events in the general population even in the absence of HF. It is unclear if NT-proBNP retains predictive value in healthy normal subjects. Methods We identified a community-based cohort of 2,042 subjects in Olmsted County, Minnesota. Subjects with symptomatic (stage C/D) HF were excluded. The remaining 1,991 subjects underwent echocardiography and NT-proBNP measurement. We further defined healthy normal (n = 703) and stage A/ B HF (n = 1,288) subgroups. Healthy normal was defined as the absence of traditional clinical cardiovascular risk factors and echocardiographic structural cardiac abnormalities. Subjects were followed for death, HF, cerebrovascular accident, and myocardial infarction with median follow-up of 9.1, 8.7, 8.8, and 8.9 years, respectively. Results NT-proBNP was not predictive of death or cardiovascular events in the healthy normal subgroup. Similar to previous reports, in stage A/ B HF, plasma NT-proBNP values greater than age-/sex-specific 80th percentiles were associated with increased risk of death, HF, cerebrovascular accident, and myocardial infarction (p < 0.001 for all) even after adjustment for clinical risk factors and structural cardiac abnormalities. Conclusions These findings do not support the use of NT-proBNP as a cardiovascular biomarker in healthy normal subjects and have important implications for NT-proBNP-based strategies for early detection and primary prevention of cardiovascular disease. (J Am Coll Cardiol 2010;55:2140-7) (C) 2010 by the American College of Cardiology Foundation
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