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N-Terminal Pro-B-Type Natriuretic Peptide Predicts Total and Cardiovascular Mortality in Individuals with or without Stable Coronary Artery Disease: The Ludwigshafen Risk and Cardiovascular Health Study

¹ Synlab Center of Laboratory Diagnostics, Heidelberg, Germany.
² Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.
³ Ludwigshafen Risk and Cardiovascular Health Study gGmbH, Freiburg, Germany.
⁴ Division of Cardiology, Department of Medicine, University of Würzburg, Würzburg, Germany.
⁵ Cardiology Group, Frankfurt-Sachsenhausen, Germany.
⁶ Division of Endocrinology, Department of Medicine, University Hospital, Ulm, Germany.

^aAddress correspondence to this author at: Synlab Center of Laboratory Diagnostics Heidelberg, PO Box 10 47 80, D-69037 Heidelberg, Germany. Fax 49-6221-793-111; e-mail maerz{at}synlab.de.

Background: Measurement of N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) measurement can be used to predict mortality in patients with acute coronary syndromes. Information on the value of NT-pro-BNP in clinically stable persons scheduled for angiography is limited.

Methods: We used Cox proportional hazards regression to examine the effect of NT-pro-BNP on total and cardiovascular mortality in 1135 with and 506 individuals without stable coronary artery disease (CAD).

Results: NT-pro-BNP was associated with New York Heart Association functional class, left ventricular (LV) systolic function, and LV end-diastolic pressure. NT-pro-BNP was positively related to age, female sex, hypertension, and former and current smoking and negatively related to body mass index and glomerular filtration rate. During a median follow-up of 5.45 years, NT-pro-BNP concentrations of 100–399, 400-1999, or 2000 ng/L resulted in unadjusted hazard ratios (95% CI) for all-cause death of 3.2 (1.8–5.6), 6.63 (3.8–11.6), and 16.5 (9.2–29.8), respectively, compared with concentrations <100 ng/L. Hazard ratios (CI) for death from cardiovascular causes were 3.8 (1.8–8.2), 9. 3 (4.4–19.5), and 22.2 (10.2–48.4). NT-pro-BNP remained predictive of total and cardiovascular mortality after accounting for age, sex, diabetes mellitus, body mass index, smoking, hypertension, dyslipidemia, glomerular filtration rate, presence or absence of CAD on angiography, cardiovascular medication, revascularization at baseline, clinical signs of heart failure, LV systolic function, and C-reactive protein.

Conclusions: NT-pro-BNP is predictive of all-cause and cardiovascular mortality in individuals with or without stable angiographic CAD independently of other cardiovascular risk factors, coronary atherosclerosis, and cardiac function.

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				K. Winkler, C. Wanner, C. Drechsler, J. Lilienthal, W. Marz, V. Krane, and for the German Diabetes and Dialysis Study Investi Change in N-terminal-pro-B-type-natriuretic-peptide and the risk of sudden death, stroke, myocardial infarction, and all-cause mortality in diabetic dialysis patients Eur. Heart J., September 1, 2008; 29(17): 2092 - 2099. [Abstract] [Full Text] [PDF]

				K. Winkler, M. M. Hoffmann, U. Seelhorst, B. Wellnitz, B. O. Boehm, B. R. Winkelmann, W. Marz, and H. Scharnagl Apolipoprotein A-II Is a Negative Risk Indicator for Cardiovascular and Total Mortality: Findings from the Ludwigshafen Risk and Cardiovascular Health Study Clin. Chem., August 1, 2008; 54(8): 1405 - 1406. [Full Text] [PDF]