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Clin Chim Acta. 2013 Apr 18;419:62-6. doi: 10.1016/j.cca.2013.01.020. Epub 2013 Feb 13.

Mid-regional pro-atrial natriuretic peptide levels in the elderly: clinical and prognostic implications, and comparison to B-type natriuretic peptides.

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Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.



Mid-regional pro-atrial natriuretic peptide (MR-proANP) is emerging as an indicator of cardiac abnormalities and adverse outcome in heart failure patients. However, there are only sparse data on its clinical value relative to the B-type natriuretic peptides in the general population.


We measured levels of MR-proANP, B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) in 999 community-dwelling subjects aged 70years who were participating in the PIVUS study.


The MR-proANP and the B-type natriuretic peptides exhibited similar associations to previous or prevalent cardiovascular disease, and echocardiographic data. In subgroups with confounding conditions (female sex, obesity, renal dysfunction), MR-proANP did not exhibit stronger associations to echocardiographic data than the B-type natriuretic peptides. MR-proANP predicted cardiovascular mortality during 8years of follow-up (adjusted hazard ratio 2.8 [95% confidence interval 1.3-6.1]) but not all-cause mortality (adjusted hazard ratio 1.6 [95% confidence interval 1.0-2.5]). Overall, NT-proBNP provided the strongest predictive value regarding both outcomes.


MR-proANP levels in an elderly community population are to a similar extent as the B-type natriuretic peptides related to manifestations of cardiovascular disease and echocardiographic data. MR-proANP also predicts long-term cardiovascular mortality but without being prognostically superior compared to the B-type natriuretic peptides.

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