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J Am Heart Assoc. 2014 Jul 22;3(4). pii: e000907. doi: 10.1161/JAHA.114.000907.

B-type natriuretic peptides for the prediction of cardiovascular events in patients with stable coronary heart disease: the Heart and Soul Study.

Author information

1
Department of Medicine, University of California, San Francisco, California (R.K.M., A.L.B., R.J., M.A.W.) San Francisco Veterans Affairs Medical Center, San Francisco, California (R.K.M., M.R., M.A.W.).
2
Department of Medicine, University of California, San Francisco, California (R.K.M., A.L.B., R.J., M.A.W.).
3
San Francisco Veterans Affairs Medical Center, San Francisco, California (R.K.M., M.R., M.A.W.).
4
Departments of Pathology & Laboratory Medicine, University of California, San Francisco, California (A.H.W.).

Abstract

BACKGROUND:

Brain-type natriuretic peptide (BNP) and the amino-terminal fragment of its prohormone (NT-proBNP) are known predictors of cardiovascular outcomes in patients with coronary heart disease; however, the relative prognostic value of these 2 biomarkers for secondary events remains unclear.

METHODS AND RESULTS:

In 983 participants with stable coronary heart disease, we evaluated the association of BNP and NT-proBNP with time to hospitalization for heart failure, nonfatal myocardial infarction, stroke or transient ischemic attack, cardiovascular death, and combined major adverse cardiovascular events (MACE). During an average follow-up of 6.5±3.3 years, both BNP and NT-proBNP were associated with increased risk of MACE in a multivariable-adjusted model (hazard ratio per standard deviation of log BNP: 1.58; 95% CI: 1.32 to 1.89; hazard ratio per standard deviation of log NT-proBNP: 1.84; 95% CI: 1.52 to 2.24). When added to traditional risk factors, NT-proBNP predicted MACE better than BNP (C statistic: 0.76 versus 0.72, P<0.001). Similarly, the addition of NT-proBNP resulted in a greater net reclassification improvement for predicting MACE than the addition of BNP (65% for NT-proBNP, 56% for BNP).

CONCLUSIONS:

Both BNP and NT-proBNP were significant predictors of MACE in stable coronary heart disease; however, NT-proBNP was superior to BNP for net risk reclassification for MACE.

KEYWORDS:

BNP; NT‐proBNP; adverse cardiovascular outcomes; risk assessment; stable coronary heart disease

PMID:
25053234
PMCID:
PMC4310375
DOI:
10.1161/JAHA.114.000907
[Indexed for MEDLINE]
Free PMC Article

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