N-Terminal Pro-Brain Natriuretic Peptide, C-Reactive Protein, and Urinary Albumin Levels as Predictors of Mortality and Cardiovascular Events in Older Adults

Abstract

Context B-type natriuretic peptides have been shown to predict cardiovascular disease in apparently healthy individuals but their predictive ability for mortality and future cardiovascular events compared with C-reactive protein (CRP) and urinary albumin/ creatinine ratio is unknown. Objective To assess the prognostic value of the N-amino terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP) vs CRP and urinary albumin/ creatinine ratio in an older adult population. Design, Setting, and Participants A population-based prospective study of 764 participants aged 50 to 89 years from a community in Copenhagen, Denmark, in which 658 participants provided blood and urinary samples and were examined between September 1, 1998, and January 24, 2000. Of these participants, 626 without heart or renal failure were enrolled. A subgroup of 537 had no history of cardiovascular disease at baseline. During 5 years of follow-up (to December 31, 2003), 94 participants died and 65 developed a first major cardiovascular event. Main Outcome Measures Risk of mortality and first major cardiovascular event by baseline levels of NT-proBNP, CRP, and urinary albumin/creatinine ratio levels. Results After adjustment for the cardiovascular risk factors of age, sex, smoking, diabetes mellitus, hypertension or ischemic heart disease, total cholesterol, and serum creatinine, the hazard ratio (HR) of mortality for values above the 80th percentile of NT-proBNP was 1.96 (95% confidence interval [CI], 1.21-3.19); for CRP, 1.46 (95% CI, 0.89-2.24); and for urinary albumin/creatinine ratio, 1.88 (95% CI, 1.18-2.98). Additional adjustment for left ventricular systolic dysfunction did not markedly attenuate the predictive value of NT-proBNP (HR, 1.82; 95% CI, 1.11-2.98). The absolute unadjusted increase in mortality risk for participants with values above the 80th percentile vs equal to or below the 80th percentile was 24.5% for NT-proBNP, 7.8% for CRP, and 19.5% for urinary albumin/creatinine ratio. The NT-proBNP levels were associated with first major cardiovascular events (nonfatal myocardial infarction, fatal coronary heart disease, unstable angina, heart failure, stroke, and transient ischemic attack) with an adjusted HR of 3.24 (95% CI, 1.80-5.79) vs 1.02 (95% CI, 0.56-1.85) for CRP and 2.32 (95% CI, 1.33-4.05) for urinary albumin/creatinine ratio when comparing participants with values above the 80th percentile with those with values equal to or below the 80th percentile. Conclusions Measurements of NT-proBNP provide prognostic information of mortality and first major cardiovascular events beyond traditional risk factors. NT-proBNP was a stronger risk biomarker for cardiovascular disease and death than CRP was in nonhospitalized individuals aged 50 to 89 years.

Level of Albuminuria and Risk of Stroke: Systematic Review and Meta-Analysis

“…1) included five studies that compared stroke risk among subjects with baseline normoalbuminuria (UAE <30 mg/day or nearest equivalent interval), microalbuminuria (UAE 30–300 mg/day or nearest equivalent interval), and macroalbuminuria (UAE >300 mg/day) [4,5,6,7,8], generating six independent adjusted stroke risk estimates. Only two studies analyzed albuminuria level versus stroke risk as a continuous variable [9,10]. There were 46,638 participants with 1,479 stroke events included in the meta-analysis.…”

Plasma Natriuretic Peptides and Incidence of Subtypes of Ischemic Stroke

“…Natriuretic peptides are often elevated in the acute situation of ischemic stroke and have been associated with a worse prognosis [3,4]. NT-proBNP and midregional pro-atrial natriuretic peptide (MR-proANP) have also been associated with an increased risk of death and cardiovascular events, including stroke in studies from the general population [5,6,7,8,9,10,11]. The reason for the relationship between natriuretic peptides and the incidence of stroke is incompletely known.…”

Correlates of N-Terminal Prohormone Brain Natriuretic Peptides in African Americans with Hypertensive Chronic Kidney Disease: The African American Study of Kidney Disease and Hypertension

“…The circulating level of NT-proBNP serves as a sensitive marker of cardiac stress and volume expansion, and elevated levels are indicative of HF [9]. Higher levels of NT-proBNP strongly predict mortality among patients with HF [10] and with acute coronary syndromes [11]. More recently, higher NT-proBNP levels have been shown to predict cardiovascular events and mortality in the general population [10, 12].…”