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

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2016 Oct 7

PMID 27711172

Citations 18

Authors

Alexander Dietl

Klaus Stark

Martina E Zimmermann

Christa Meisinger

Heribert Schunkert

Christoph Birner

Lars S Maier

Annette Peters

Iris M Heid

Andreas Luchner

Affiliations

Soon will be listed here.

Abstract

Aims: 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).

Methods And Results: 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.

Conclusion: 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.

Citing Articles

The Role of NT-proBNP Levels in the Diagnosis of Hypertensive Heart Disease.

Mouzarou A, Hadjigeorgiou N, Melanarkiti D, Plakomyti T Diagnostics (Basel). 2025; 15(1.

PMID: 39795641 PMC: 11719755. DOI: 10.3390/diagnostics15010113.

A Study of Abnormal Echocardiogram Findings in Patients With Chronic Kidney Disease With Reference to Cardiac Biomarkers.

Shende P, Reddy A, Vikhe V, Patil R, Faruqi A, Khandol D Cureus. 2024; 16(7):e65398.

PMID: 39184755 PMC: 11344873. DOI: 10.7759/cureus.65398.

Serum N-Terminal Pro-B-Type Natriuretic Peptide Level is Negatively Associated with Vascular Reactivity Index by Digital Thermal Monitoring in Patients with Hypertension.

Hsiao C, Yang C, Wang J, Hsu B Rev Cardiovasc Med. 2024; 25(6):214.

PMID: 39076346 PMC: 11270078. DOI: 10.31083/j.rcm2506214.

BNP and NT-proBNP Thresholds for the Assessment of Prognosis in Patients Without Heart Failure.

Jehn S, Mahabadi A, Pfohl C, Vogel L, Al-Rashid F, Luedike P JACC Adv. 2024; 2(10):100688.

PMID: 38938478 PMC: 11198633. DOI: 10.1016/j.jacadv.2023.100688.

A Biomarker-Based Diagnostic Model for Cardiac Dysfunction in Childhood Cancer Survivors.

Leerink J, Feijen E, de Baat E, Merkx R, van der Pal H, Tissing W JACC CardioOncol. 2024; 6(2):236-247.

PMID: 38774012 PMC: 11103045. DOI: 10.1016/j.jaccao.2024.02.008.

References

Portegies M, Kavousi M, Leening M, Bos M, van den Meiracker A, Hofman A . N-terminal pro-B-type natriuretic peptide and the risk of stroke and transient ischaemic attack: the Rotterdam Study. Eur J Neurol. 2015; 22(4):695-701. DOI: 10.1111/ene.12633. View

Heid I, Boes E, Muller M, Kollerits B, Lamina C, Coassin S . Genome-wide association analysis of high-density lipoprotein cholesterol in the population-based KORA study sheds new light on intergenic regions. Circ Cardiovasc Genet. 2009; 1(1):10-20. DOI: 10.1161/CIRCGENETICS.108.776708. View

Laukkanen J, Kurl S, Ala-Kopsala M, Vuolteenaho O, Ruskoaho H, Nyyssonen K . Plasma N-terminal fragments of natriuretic propeptides predict the risk of cardiovascular events and mortality in middle-aged men. Eur Heart J. 2006; 27(10):1230-7. DOI: 10.1093/eurheartj/ehi878. View

Eckel R, Jakicic J, Ard J, de Jesus J, Miller N, Hubbard V . 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013; 63(25 Pt B):2960-84. DOI: 10.1016/j.jacc.2013.11.003. View

Teichholz L, KREULEN T, Herman M, Gorlin R . Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence of absence of asynergy. Am J Cardiol. 1976; 37(1):7-11. DOI: 10.1016/0002-9149(76)90491-4. View

Maragiannis D, Nagueh S . Echocardiographic evaluation of left ventricular diastolic function: an update. Curr Cardiol Rep. 2015; 17(2):3. DOI: 10.1007/s11886-014-0561-9. View

Mosterd A, Hoes A, de Bruyne M, Deckers J, Linker D, Hofman A . Prevalence of heart failure and left ventricular dysfunction in the general population; The Rotterdam Study. Eur Heart J. 1999; 20(6):447-55. View

Cohn J, Ferrari R, Sharpe N . Cardiac remodeling--concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an International Forum on Cardiac Remodeling. J Am Coll Cardiol. 2000; 35(3):569-82. DOI: 10.1016/s0735-1097(99)00630-0. View

Wang T, Larson M, Levy D, Benjamin E, Leip E, Omland T . Plasma natriuretic peptide levels and the risk of cardiovascular events and death. N Engl J Med. 2004; 350(7):655-63. DOI: 10.1056/NEJMoa031994. View

10.

. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010; 33 Suppl 1:S62-9. PMC: 2797383. DOI: 10.2337/dc10-S062. View

11.

Pastormerlo L, Maffei S, Della Latta D, Chubuchny V, Susini C, Berti S . N-terminal prob-type natriuretic peptide is a marker of vascular remodelling and subclinical atherosclerosis in asymptomatic hypertensives. Eur J Prev Cardiol. 2015; 23(4):366-76. DOI: 10.1177/2047487315569675. View

12.

Kathiresan S, Gona P, Larson M, Vita J, Mitchell G, Tofler G . Cross-sectional relations of multiple biomarkers from distinct biological pathways to brachial artery endothelial function. Circulation. 2006; 113(7):938-45. DOI: 10.1161/CIRCULATIONAHA.105.580233. View

13.

Folsom A, Yao L, Alonso A, Lutsey P, Missov E, Lederle F . Circulating Biomarkers and Abdominal Aortic Aneurysm Incidence: The Atherosclerosis Risk in Communities (ARIC) Study. Circulation. 2015; 132(7):578-85. PMC: 4543558. DOI: 10.1161/CIRCULATIONAHA.115.016537. View

14.

Kara K, Lehmann N, Neumann T, Kalsch H, Mohlenkamp S, Dykun I . NT-proBNP is superior to BNP for predicting first cardiovascular events in the general population: the Heinz Nixdorf Recall Study. Int J Cardiol. 2015; 183:155-61. DOI: 10.1016/j.ijcard.2015.01.082. View

15.

Birner C, Dietl A, Deutzmann R, Schroder J, Schmid P, Jungbauer C . Proteomic profiling implies mitochondrial dysfunction in tachycardia-induced heart failure. J Card Fail. 2012; 18(8):660-73. DOI: 10.1016/j.cardfail.2012.06.418. View

16.

Devereux R, Roman M, Paranicas M, Lee E, Welty T, Fabsitz R . A population-based assessment of left ventricular systolic dysfunction in middle-aged and older adults: the Strong Heart Study. Am Heart J. 2001; 141(3):439-46. DOI: 10.1067/mhj.2001.113223. View

17.

Burton R . Estimating body surface area from mass and height: theory and the formula of Du Bois and Du Bois. Ann Hum Biol. 2008; 35(2):170-84. DOI: 10.1080/03014460801908439. View

18.

Schiller N, Shah P, Crawford M, DeMaria A, Devereux R, FEIGENBAUM H . Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989; 2(5):358-67. DOI: 10.1016/s0894-7317(89)80014-8. View

19.

Bower J, Lazo M, Matsushita K, Rubin J, Hoogeveen R, Ballantyne C . N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP) and Risk of Hypertension in the Atherosclerosis Risk in Communities (ARIC) Study. Am J Hypertens. 2015; 28(10):1262-6. PMC: 4580540. DOI: 10.1093/ajh/hpv026. View

20.

Patterson C, Blankenberg S, Ben-Shlomo Y, Heslop L, Bayer A, Lowe G . Which biomarkers are predictive specifically for cardiovascular or for non-cardiovascular mortality in men? Evidence from the Caerphilly Prospective Study (CaPS). Int J Cardiol. 2015; 201:113-8. PMC: 4612445. DOI: 10.1016/j.ijcard.2015.07.106. View