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Mughal HB, Majeed AI, Aftab M, Ubaid MF, Zahra S, Abbasi MSR, Qadir M, Ahmad M, Akbar A, Tasneem S, Jadoon SK, Tariq M, Hussain S, Khandker SS, Alvi S. Brain natriuretic peptide in acute heart failure and its association with glomerular filtration rate: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e36933. [PMID: 38394539 PMCID: PMC11309607 DOI: 10.1097/md.0000000000036933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 12/20/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Acute heart failure (AHF) is one of the most common cardiovascular diseases. Early diagnosis and prognosis are essential, as they can eventually lead to a fatal condition. Recently, brain natriuretic peptide (BNP) has been recognized as one of the most popular biomarkers for AHF. Changes in glomerular filtration rate (GFR) are often observed in AHF. METHODS We searched PubMed, Google Scholar, and ScienceDirect between March and June 2023. Original case control studies written in English that assessed levels oh BNP in AHF were included. Systematic reviews, letters to editor, correspondence, comprehensive reviews, and duplicated studies were excluded. Funnel plots were constructed to assess publication bias. RESULTS A total of 9 studies were selected and we obtained the mean difference (MD) of BNP level to be 2.57 (95% CI: 1.35, 3.78), and GFR to be -15.52, (95% CI: -23.35, -7.70) in AHF patients. Sensitivity analyses supported the robustness of the outcome. CONCLUSION Results indicated that BNP was a promising prognostic biomarker of AHF, whereas GFR was found to be negatively correlated with AHF.
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Affiliation(s)
- Hamdah Bashir Mughal
- Registered Medical Practitioner, Azad Jammu & Kashmir Medical College, Muzaffarabad, Azad Jammu and Kashmir, Pakistan
| | | | - Maria Aftab
- Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | | | - Sabahat Zahra
- Acute and General Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | | | - Mamoon Qadir
- Head of Cardiology Department Fed Govt Polyclinic and Kulsum International Hospital, Islamabad, Pakistan
| | - Mumtaz Ahmad
- Abbas Institute of Medical Sciences, Muzaffarabad AJK, Pakistan
| | - Amna Akbar
- District Headquarter Hospital Jhelum Valley, Muzaffarabad AJK, Pakistan
| | | | | | - Maham Tariq
- Gujranwala, Teaching Hospital, Gujranwala, Pakistan
| | | | | | - Sarosh Alvi
- Teaching Faculty, University of Khartoum, Khartoum, Sudan
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Abstract
The prevalence of heart failure (HF), including reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF), has increased significantly worldwide. However, the prognosis and treatment of HF are still not good. Recent studies have demonstrated that high-density lipoprotein (HDL) plays an important role in cardiac repair during HF. The exact role and mechanism of HDL in the regulation of HF remain unexplained. Here, we discuss recent findings regarding HDL in the progression of HF, such as the regulation of excitation-contraction coupling, energy homeostasis, inflammation, neurohormone activation, and microvascular dysfunction. The effects of HDL on the regulation of cardiac-related cells, such as endothelial cells (ECs), cardiomyocytes (CMs), and on cardiac resident immune cell dysfunction in HF are also explained. An in-depth understanding of HDL function in the heart may provide new strategies for the prevention and treatment of HF.
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Van Remoortel H, Hornikx M, Langer D, Burtin C, Everaerts S, Verhamme P, Boonen S, Gosselink R, Decramer M, Troosters T, Janssens W. Risk factors and comorbidities in the preclinical stages of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2014; 189:30-8. [PMID: 24219412 DOI: 10.1164/rccm.201307-1240oc] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE There is little information about comorbidities and their risk factors in the preclinical stages of chronic obstructive pulmonary disease (COPD). OBJECTIVES This study aims to investigate the prevalence of premorbid risk factors and comorbid diseases and its association with daily physical activity in subjects detected with COPD by spirometry screening. METHODS Sixty subjects with preclinical COPD (63 ± 6 yr; 68% [n = 41] male) were compared with 60 smoking control subjects (62 ± 7 yr; 70% [n = 42] male) and 60 never-smoking control subjects (62 ± 6 yr; 57% [n = 34] male). Comorbidities (cardiovascular, metabolic, and musculoskeletal disease) and daily physical activity (by multisensor activity monitor) were measured objectively. MEASUREMENTS AND MAIN RESULTS The prevalence of premorbid risk factors and comorbid diseases was significantly higher in preclinical COPD compared with age-matched never-smoking control subjects, but was similar to smoking control subjects not suffering from COPD. In preclinical COPD and smoking control subjects, the combination of cardiovascular disease and musculoskeletal disease was the most prevalent (15% [n = 9] and 12% [n = 7], respectively). In a multivariate logistic regression analysis, physical inactivity and smoking were found to be independent risk factors for having greater than or equal to two comorbidities. CONCLUSIONS Premorbid risk factors and comorbid diseases were more prevalent in the preclinical stages of COPD and smokers without COPD. Physical inactivity and smoking were more strongly associated with the presence of comorbidities compared with airflow obstruction. Clinical trial registered with www.clinicaltrials.gov (NCT 01314807).
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Affiliation(s)
- Hans Van Remoortel
- 1 Faculty of Kinesiology and Rehabilitation Sciences, Department of Rehabilitation Sciences
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Mirjafari H, Welsh P, Verstappen SMM, Wilson P, Marshall T, Edlin H, Bunn D, Chipping J, Lunt M, Symmons DPM, Sattar N, Bruce IN. N-terminal pro-brain-type natriuretic peptide (NT-pro-BNP) and mortality risk in early inflammatory polyarthritis: results from the Norfolk Arthritis Registry (NOAR). Ann Rheum Dis 2013; 73:684-90. [PMID: 23511225 PMCID: PMC3963600 DOI: 10.1136/annrheumdis-2012-202848] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background We measured N-terminal pro-brain natriuretic peptide (NT-pro-BNP), a marker of cardiac dysfunction, in an inception cohort with early inflammatory polyarthritis (IP) and assessed its association with disease phenotype, cardiovascular disease (CVD), all-cause and CVD related mortality. Methods Subjects with early IP were recruited to the Norfolk Arthritis Register from January 2000 to December 2008 and followed up to death or until March 2010 including any data from the national death register. The associations of baseline NT-pro-BNP with IP related factors and CVD were assessed by linear regression. Cox proportional hazards models examined the independent association of baseline NT-pro-BNP with all-cause and CVD mortality. Results We studied 960 early IP subjects; 163 (17%) had prior CVD. 373 (39%) patients had a baseline NT-pro-BNP levels ≥100 pg/ml. NT-pro-BNP was associated with age, female gender, HAQ score, CRP, current smoking, history of hypertension, prior CVD and the presence of carotid plaque. 92 (10%) IP subjects died including 31 (3%) from CVD. In an age and gender adjusted analysis, having a raised NT-pro-BNP level (≥100 pg/ml) was associated with both all-cause and CVD mortality (adjusted HR (95% CI) 2.36 (1.42 to 3.94) and 3.40 (1.28 to 9.03), respectively). These findings were robust to adjustment for conventional CVD risk factors and prevalent CVD. Conclusions In early IP patients, elevated NT-pro-BNP is related to HAQ and CRP and predicts all-cause and CVD mortality independently of conventional CVD risk factors. Further study is required to identify whether NT-pro-BNP may be clinically useful in targeting intensive interventions to IP patients at greatest risk of CVD.
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Affiliation(s)
- Hoda Mirjafari
- Arthritis Research UK Epidemiology Unit, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, , Manchester, UK
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Fang Z, Zhou L, Bao Y, Ding W, Shi H, Luo X, Hu R. Association of NT-proBNP and multiple biomarkers with severity of angiographic coronary artery disease in diabetic and pre-diabetic Chinese patients. PLoS One 2011; 6:e22563. [PMID: 21857933 PMCID: PMC3156698 DOI: 10.1371/journal.pone.0022563] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 06/23/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known about the plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), and the relationship between the severity of coronary heart disease (CHD) with NT-proBNP and multiple biomarkers in diabetic and pre-diabetic patients, compared to individuals with normal glucose levels. METHODS Four hundred and fifteen consecutive Chinese patients of both sexes were assigned to three groups on the basis of the new hemoglobin (Hb) A1c (HbA1c) cut-off points for diagnosis of diabetes and pre-diabetes. The three groups were divided into tertiles according to NT-proBNP, hs-CRP, cystatin C, and troponin T levels. Gensini scores were compared among the three groups and biomarker tertiles. Receiver operating characteristic (ROC) curves were used to obtain the angiographic CHD cut-off points for each biomarker. Stepwise multivariate linear correlation analysis was applied to examine the association between the severity of CHD and biomarker levels. RESULTS Gensini scores increased with increasing biomarker tertile levels and HbA1c. Gensini scores were significantly different in the middle and upper NT-proBNP tertiles of the diabetic, pre-diabetic and control groups. NT-proBNP had the highest positive and negative predictive values and area under the curve for CHD. Only NT-proBNP was identified as an independent variable for Gensini score. CONCLUSIONS Plasma NT-proBNP may be an important biomarker to evaluate the severity of CHD and screen for CHD in diabetic or pre-diabetic patients.
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Affiliation(s)
- Zhou Fang
- Institute of Endocrinology and Diabeteology, Shanghai, China
- State Key Laboratory of Genetic Engineering, Shanghai, China
| | - Linuo Zhou
- Department of Endocrinology and Metabolism, Huashan Hospital of Fudan University, Shanghai, China
| | - Yuanyuan Bao
- Department of Endocrinology and Metabolism, Huashan Hospital of Fudan University, Shanghai, China
| | - Wei Ding
- Department of Endocrinology and Metabolism, Huashan Hospital of Fudan University, Shanghai, China
| | - Haiming Shi
- Department of Cardiology, Huashan Hospital at Fudan University, Shanghai, China
| | - Xinping Luo
- Department of Cardiology, Huashan Hospital at Fudan University, Shanghai, China
| | - Renming Hu
- Department of Endocrinology and Metabolism, Huashan Hospital of Fudan University, Shanghai, China
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Otsuka T, Kawada T, Seino Y, Ibuki C, Katsumata M, Kodani E. Relation of smoking status to serum levels of N-terminal pro-brain natriuretic peptide in middle-aged men without overt cardiovascular disease. Am J Cardiol 2010; 106:1456-60. [PMID: 21059436 DOI: 10.1016/j.amjcard.2010.06.075] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 06/28/2010] [Accepted: 06/28/2010] [Indexed: 10/19/2022]
Abstract
Cigarette smoking impairs arterial function and promotes atherosclerosis. However, whether smoking status is associated with cardiac overload has not yet been fully examined, particularly from an epidemiologic viewpoint. The present study examined the relation of smoking status to serum levels of N-terminal pro-brain natriuretic peptide (NT-pro-BNP), a marker of cardiac overload, in middle-aged men without overt cardiovascular disease. Serum NT-pro-BNP levels were measured in a work-site based population of 969 men (mean age 44 ± 6 years) who did not have any history or presence of cardiovascular disease. Smoking status was evaluated by self-reported questionnaire. Four hundred fifty-nine, 222, and 288 subjects were never, former, and current smokers, respectively. NT-pro-BNP levels were significantly higher in current smokers (21.7 ± 2.3 pg/ml) than in never smokers (17.9 ± 2.1 pg/ml, p <0.001). This significant difference was maintained even after adjusting for age, obesity, heart rate, hypertension, dyslipidemia, impaired fasting glucose/diabetes mellitus, left ventricular hypertrophy, estimated glomerular filtration rate, high-sensitivity C-reactive protein, alcohol consumption, and regular exercise. Current smokers had an increased odds ratio (3.04, 95% confidence interval 1.64 to 5.61, p <0.001) for elevated NT-pro-BNP (>54.5 pg/ml) compared to never smokers, even after adjusting for the studied variables. In contrast, former smokers did not show a significantly increased odds ratio for elevated NT-pro-BNP. NT-pro-BNP levels showed a weak, but significant negative correlation with duration of smoking cessation (partial r = -0.15, p = 0.034) in former smokers. In conclusion, these results suggest that cigarette smoking increases cardiac overload, whereas smoking cessation ameliorates these conditions.
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Dent THS. Predicting the risk of coronary heart disease. II: the role of novel molecular biomarkers and genetics in estimating risk, and the future of risk prediction. Atherosclerosis 2010; 213:352-62. [PMID: 20619412 DOI: 10.1016/j.atherosclerosis.2010.06.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 06/10/2010] [Indexed: 01/30/2023]
Abstract
This is the second of two articles reviewing recent findings about the risk of coronary heart disease. This paper is concerned with novel molecular biomarkers, genetic markers of risk and the future of risk prediction.
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Affiliation(s)
- T H S Dent
- PHG Foundation, 2 Worts Causeway, Cambridge CB1 8RN, United Kingdom.
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Daniels LB. Natriuretic Peptides and Assessment of Cardiovascular Disease Risk in Asymptomatic Persons. CURRENT CARDIOVASCULAR RISK REPORTS 2010; 4:120-127. [PMID: 20672100 PMCID: PMC2894089 DOI: 10.1007/s12170-010-0078-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Current tools for cardiovascular disease (CVD) risk assessment in asymptomatic individuals are imperfect. Preventive measures aimed only at individuals deemed high risk by current algorithms neglect large numbers of low-risk and intermediate-risk individuals who are destined to develop CVD and who would benefit from early and aggressive treatment. Natriuretic peptides have the potential both to identify individuals at risk for future cardiovascular events and to help detect subclinical CVD. Choosing the appropriate subpopulation to target for natriuretic peptide testing will help maximize the performance and the cost effectiveness. The combined use of multiple risk markers, including biomarkers, genetic testing, and imaging or other noninvasive measures of risk, offers promise for further refining risk assessment algorithms. Recent studies have highlighted the utility of natriuretic peptides for preoperative risk stratification; however, cost effectiveness and outcomes studies are needed to affirm this and other uses of natriuretic peptides for cardiovascular risk assessment in asymptomatic individuals.
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Affiliation(s)
- Lori B. Daniels
- Division of Cardiology, University of California, San Diego, MC 0986, 9350 Campus Point Drive, Suite 1D, La Jolla, CA 92037-1300 USA
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Di Angelantonio E, Chowdhury R, Sarwar N, Ray KK, Gobin R, Saleheen D, Thompson A, Gudnason V, Sattar N, Danesh J. B-Type Natriuretic Peptides and Cardiovascular Risk. Circulation 2009; 120:2177-87. [DOI: 10.1161/circulationaha.109.884866] [Citation(s) in RCA: 291] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background—
Measurement of B-type natriuretic peptide (BNP) concentration or its precursor (N-terminal fragment [NT-proBNP]) is recommended in patients with symptoms of left ventricular dysfunction and in other settings, but the relevance of these peptides to cardiovascular disease (CVD) in general populations or in patients with stable vascular disease is uncertain.
Methods and Results—
Data were collated from 40 long-term prospective studies involving a total of 87 474 participants and 10 625 incident CVD outcomes. In a comparison of individuals in the top third with those in the bottom third of baseline values of natriuretic peptides, the combined risk ratio (RR), adjusted for several conventional risk factors, was 2.82 (95% confidence interval [CI], 2.40 to 3.33) for CVD. Analysis of the 6 studies with at least 250 CVD outcomes (which should be less prone to selective reporting than are smaller studies) yielded an adjusted RR of 1.94 (95% CI, 1.57 to 2.39). RRs were broadly similar with BNP or NT-proBNP (RR, 2.89 [95% CI, 1.91 to 4.38] and 2.82 [95% CI, 2.35 to 3.38], respectively) and by different baseline vascular risk (RR, 2.68 [95% CI, 2.07 to 3.47] in approximately general populations; RR, 3.35 [95% CI, 2.38 to 4.72] in people with elevated vascular risk factors; RR, 2.60 [95% CI, 1.99 to 3.38] in patients with stable CVD). Assay of BNP or NT-proBNP in addition to measurement of conventional CVD risk factors yielded generally modest improvements in risk discrimination.
Conclusions—
Available prospective studies indicate strong associations between circulating concentration of natriuretic peptides and CVD risk under a range of different circumstances. Further investigation is warranted, particularly in large general population studies, to clarify any predictive utility of these markers and to better control for publication bias.
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Affiliation(s)
- Emanuele Di Angelantonio
- From the Department of Public Health and Primary Care, University of Cambridge, Cambridge, England (E.D.A., R.C., N. Sarwar, K.K.R., R.G., A.T., D.S., J.D.); Section of Population Health Sciences, University of Aberdeen, Aberdeen, Scotland (N. Sarwar); BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland (N. Sattar); and Icelandic Heart Association, Kopavogur, and University of Iceland, Reykjavik (V.G.)
| | - Rajiv Chowdhury
- From the Department of Public Health and Primary Care, University of Cambridge, Cambridge, England (E.D.A., R.C., N. Sarwar, K.K.R., R.G., A.T., D.S., J.D.); Section of Population Health Sciences, University of Aberdeen, Aberdeen, Scotland (N. Sarwar); BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland (N. Sattar); and Icelandic Heart Association, Kopavogur, and University of Iceland, Reykjavik (V.G.)
| | - Nadeem Sarwar
- From the Department of Public Health and Primary Care, University of Cambridge, Cambridge, England (E.D.A., R.C., N. Sarwar, K.K.R., R.G., A.T., D.S., J.D.); Section of Population Health Sciences, University of Aberdeen, Aberdeen, Scotland (N. Sarwar); BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland (N. Sattar); and Icelandic Heart Association, Kopavogur, and University of Iceland, Reykjavik (V.G.)
| | - Kausik K. Ray
- From the Department of Public Health and Primary Care, University of Cambridge, Cambridge, England (E.D.A., R.C., N. Sarwar, K.K.R., R.G., A.T., D.S., J.D.); Section of Population Health Sciences, University of Aberdeen, Aberdeen, Scotland (N. Sarwar); BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland (N. Sattar); and Icelandic Heart Association, Kopavogur, and University of Iceland, Reykjavik (V.G.)
| | - Reeta Gobin
- From the Department of Public Health and Primary Care, University of Cambridge, Cambridge, England (E.D.A., R.C., N. Sarwar, K.K.R., R.G., A.T., D.S., J.D.); Section of Population Health Sciences, University of Aberdeen, Aberdeen, Scotland (N. Sarwar); BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland (N. Sattar); and Icelandic Heart Association, Kopavogur, and University of Iceland, Reykjavik (V.G.)
| | - Danish Saleheen
- From the Department of Public Health and Primary Care, University of Cambridge, Cambridge, England (E.D.A., R.C., N. Sarwar, K.K.R., R.G., A.T., D.S., J.D.); Section of Population Health Sciences, University of Aberdeen, Aberdeen, Scotland (N. Sarwar); BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland (N. Sattar); and Icelandic Heart Association, Kopavogur, and University of Iceland, Reykjavik (V.G.)
| | - Alexander Thompson
- From the Department of Public Health and Primary Care, University of Cambridge, Cambridge, England (E.D.A., R.C., N. Sarwar, K.K.R., R.G., A.T., D.S., J.D.); Section of Population Health Sciences, University of Aberdeen, Aberdeen, Scotland (N. Sarwar); BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland (N. Sattar); and Icelandic Heart Association, Kopavogur, and University of Iceland, Reykjavik (V.G.)
| | - Vilmundur Gudnason
- From the Department of Public Health and Primary Care, University of Cambridge, Cambridge, England (E.D.A., R.C., N. Sarwar, K.K.R., R.G., A.T., D.S., J.D.); Section of Population Health Sciences, University of Aberdeen, Aberdeen, Scotland (N. Sarwar); BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland (N. Sattar); and Icelandic Heart Association, Kopavogur, and University of Iceland, Reykjavik (V.G.)
| | - Naveed Sattar
- From the Department of Public Health and Primary Care, University of Cambridge, Cambridge, England (E.D.A., R.C., N. Sarwar, K.K.R., R.G., A.T., D.S., J.D.); Section of Population Health Sciences, University of Aberdeen, Aberdeen, Scotland (N. Sarwar); BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland (N. Sattar); and Icelandic Heart Association, Kopavogur, and University of Iceland, Reykjavik (V.G.)
| | - John Danesh
- From the Department of Public Health and Primary Care, University of Cambridge, Cambridge, England (E.D.A., R.C., N. Sarwar, K.K.R., R.G., A.T., D.S., J.D.); Section of Population Health Sciences, University of Aberdeen, Aberdeen, Scotland (N. Sarwar); BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland (N. Sattar); and Icelandic Heart Association, Kopavogur, and University of Iceland, Reykjavik (V.G.)
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Akanji AO, Suresh CG, Al-Radwan R, Fatania HR. Body Mass and Atherogenic Dyslipidemia as Major Determinants of Blood Levels of B-Type Natriuretic Peptides in Arab Subjects With Acute Coronary Syndromes. Metab Syndr Relat Disord 2009; 7:563-9. [DOI: 10.1089/met.2009.0034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Abayomi O. Akanji
- Departments of Pathology, Kuwait University Faculty of Medicine, Kuwait
| | - Cheriyil G. Suresh
- Cardiology Unit, Department of Medicine, Mubarak Al-Kabir Hospital, Kuwait
| | | | - Hasmukh R. Fatania
- Departments of Biochemistry, Kuwait University Faculty of Medicine, Kuwait
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Ramos LWF, Murad N, Goto E, Antônio EL, Silva JA, Tucci PF, Carvalho AC. Ischemia/reperfusion is an independent trigger for increasing myocardial content of mRNA B-type natriuretic peptide. Heart Vessels 2009; 24:454-9. [DOI: 10.1007/s00380-009-1148-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Accepted: 01/15/2009] [Indexed: 11/29/2022]
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NT-proBNP is associated with coronary heart disease risk in healthy older women but fails to enhance prediction beyond established risk factors: results from the British Women's Heart and Health Study. Atherosclerosis 2009; 209:295-9. [PMID: 19815210 DOI: 10.1016/j.atherosclerosis.2009.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 08/18/2009] [Accepted: 09/09/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Limited evidence suggests NT-proBNP improves prediction of coronary heart disease (CHD) events but further data are needed, especially in people without pre-existing CHD and in women. METHODS We measured NT-proBNP in serum from 162 women with incident CHD events and 1226 controls (60-79 years) in a case-control study nested within the prospective British Women's Heart and Health Study. All cases and controls were free from CHD at baseline. We related NT-proBNP to CHD event risk, and determined to what extent NT-proBNP enhanced CHD risk prediction beyond established risk factors. RESULTS The odds ratio for CHD per 1 standard deviation increase in log(e)NT-proBNP was 1.37 (95% CI: 1.13-1.68) in analyses adjusted for established CHD risk factors, social class, CRP and insulin. However, addition of log(e)NT-proBNP did not improve the discrimination of a prediction model including age, social class, smoking, physical activity, lipids, fasting glucose, waist:hip ratio, hypertension, statin and aspirin use, nor a standard Framingham risk score model; area under the receiver operator curve for the former model increased from 0.676 to 0.687 on inclusion of NT-proBNP (p=0.3). Furthermore, adding NT-proBNP did not improve calibration of a prediction model containing established risk factors, nor did inclusion more appropriately re-classify participants in relation to their final outcome. Findings were similar (independent associations, but no prediction improvement) for fasting insulin and CRP. CONCLUSION These results caution against use of NT-proBNP for CHD risk prediction in healthy women and suggest a need for larger studies in both genders to resolve outstanding uncertainties.
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Reddy KJ, Singh M, Bangit JR, Batsell RR. The role of lipoprotein-associated phospholipase A2 on cardiovascular disease risk assessment and plaque rupture: a clinical review. J Clin Lipidol 2009; 3:85-93. [DOI: 10.1016/j.jacl.2009.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 01/17/2009] [Indexed: 12/11/2022]
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14
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Romano S, Necozione S, Guarracini L, Fratini S, Cisternino P, di Orio F, Penco M. Accuracy of N-terminal pro-brain natriuretic peptide in the identification of left ventricular dysfunction in high-risk asymptomatic patients. J Cardiovasc Med (Hagerstown) 2009; 10:238-44. [PMID: 19262210 DOI: 10.2459/jcm.0b013e3283212ee0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The role of natriuretic peptides in the screening of left ventricular dysfunction is still unclear. The aim of this study was to assess the usefulness of N-terminal pro-brain natriuretic peptide (NT-proBNP) measurement in asymptomatic patients at high risk of developing left ventricular dysfunction. METHODS One hundred and thirty-four consecutive ambulatory patients (mean age 56.1 +/- 7 years) were studied and selected on the basis of a history of hypertension of at least 5 years. Systolic dysfunction was defined as an ejection fraction of 45% or less. Statistical analysis was performed by both parametric and nonparametric approaches. Diagnostic accuracy was evaluated by receiver operating characteristic analysis. RESULTS Echocardiography showed normal left ventricular function in 40 patients, diastolic dysfunction in 80 patients and systolic dysfunction in 14 patients. NT-proBNP levels were significantly higher in patients with systolic dysfunction (356.1 +/- 294.8 vs. 85.2 +/- 85.8 pg/ml; P < 0.05). Receiver operating characteristic analysis showed a high value of the area under the curve (0.89) for the detection of systolic dysfunction with a sensitivity of 83% and a specificity of 80% for a cut-off value of 114 pg/ml and with a negative predictive value of 0.98. CONCLUSION In asymptomatic patients at high risk for heart failure because of a history of hypertension, the measurement of NT-proBNP levels may represent a useful screening test for left ventricular systolic dysfunction. Therefore, more expensive examinations, such as echocardiography, may be restricted only to patients with higher NT-proBNP levels.
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Affiliation(s)
- Silvio Romano
- Department of Internal Medicine and Public Health, University of L'Aquila, Italy.
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Welsh P, Packard CJ, Sattar N. Novel antecedent plasma biomarkers of cardiovascular disease: improved evaluation methods and comparator benchmarks raise the bar. Curr Opin Lipidol 2008; 19:563-71. [PMID: 18957878 DOI: 10.1097/mol.0b013e32831551e0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW To assess recent advances in cardiovascular disease biomarkers, focusing on past failings, current promise, and areas for future work. RECENT FINDINGS Despite intense interest in novel biomarkers, few have yet to show utility in improving cardiovascular disease risk scores as assessed by predictive statistical models. Indeed, there is current debate as to how to evaluate clinical utility. There is increasing interest in biomarkers from pathophysiological pathways other than inflammation (cardiac signals, renal function, metabolic measures, novel lipids, nutritional, etc), as well as interest in combining such markers in panels to increase cardiovascular disease risk discrimination, and in 'omics' techniques. A challenge to the biomarker concept in cardiovascular disease is the contribution of other factors - for example, socioeconomic position or family history of premature cardiovascular disease - that present cheaper and more efficient way of gaining discrimination. Some have been added already to risk score guidelines in some countries. Whether novel plasma biomarkers can add further prediction requires study. SUMMARY The jury is still out on the ability of biomarkers to enhance risk scores in a cost-efficient way. New technologies and statistical models may optimize efforts but use of simpler lifestyle and demographic markers in recent risk scores revisions have raised the bar.
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Affiliation(s)
- Paul Welsh
- Division of Cardiovascular and Medical Sciences, Faculty of Medicine, University of Glasgow, Scotland, UK.
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Abstract
Morphological and immunocytochemical studies have elucidated the complex processes involved in atherogenesis. The notion of plaque instability has emerged from this work and underscored the importance of inflammation in determining clinical complications associated with atherosclerosis, such as acute coronary syndrome. Cells of the immune system have been detected within atherosclerotic lesions and auto-antibodies directed against modified LDL and heat-shock proteins have been identified in the blood of individuals with atherosclerosis. The use of risk 'engines', e.g. the Framingham coronary risk score, has facilitated the identification of individuals at high risk, but the constituent classical risk factors used in these algorithms do not adequately differentiate individuals at moderate risk. As age is a major component of the equations used in these algorithms they are not particularly useful in young adults, and their applicability to non-Caucasian populations has been questioned. Biomarkers of early disease and plaque instability have therefore both been sought. Although some of these markers have been shown individually to be associated with a significant hazard ratio, no substantial improvement in discrimination has been demonstrated when they are incorporated into a risk 'engine'. The latter has generally been assessed by receiver operator characteristic curve analysis, although this approach has been criticised. Other modalities, including imaging and functional assessments of vascular function, are now being developed for clinical use.
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Maeder MT, Mueller C, Pfisterer ME, Buser PT, Brunner-La Rocca HP. Use of B-type natriuretic peptide outside of the emergency department. Int J Cardiol 2008; 127:5-16. [DOI: 10.1016/j.ijcard.2007.10.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2006] [Revised: 08/03/2007] [Accepted: 10/20/2007] [Indexed: 10/22/2022]
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Brune K, Katus HA, Moecks J, Spanuth E, Jaffe AS, Giannitsis E. N-terminal pro-B-type natriuretic peptide concentrations predict the risk of cardiovascular adverse events from antiinflammatory drugs: a pilot trial. Clin Chem 2008; 54:1149-57. [PMID: 18451314 DOI: 10.1373/clinchem.2007.097428] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND we investigated whether higher concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP) predicts cardiovascular adverse events (CV-AEs) in patients with osteoarthritis treated with antiinflammatory drugs. METHODS NT-proBNP was measured in baseline samples from 433 patients enrolled in a prospective randomized study designed to test the therapeutic effect of a novel metalloproteinase inhibitor. We monitored CV-AEs and retrospectively investigated their relationship to the concomitant use of selective cyclooxygenase-2 inhibitors (coxibs), traditional nonsteroidal antiinflammatory drugs (tNSAIDs), and glucocorticoids. CV-AEs included myocardial infarction, stroke, new or worsening of preexisting arterial hypertension, congestive heart failure, and several less severe CV-AEs. RESULTS we observed 82 mild to serious CV-AEs during an observational period of 200 days. The risk of such events was 1.95-fold higher in patients who were taking tNSAIDs, glucocorticoids, or coxibs (i.e., any inhibitor) and who had NT-proBNP concentrations > or = 100 ng/L than in patients taking any inhibitor who had NT-proBNP values <100 ng/L (P < 0.05). Patients taking coxibs (alone or in addition to tNSAIDs or glucocorticoids) with baseline NT-proBNP values > or = 100 ng/L had a 7.41-fold higher risk for CV-AEs than those with baseline values <100 ng/L (P < 0.01). Patients who were taking 2 or more antiinflammatory drugs and had NT-proBNP values > or = 100 ng/L had a 3.74-fold higher risk for CV-AEs than those with NT-proBNP values <100 ng/L (P < 0.05). An NT-proBNP value <100 ng/L was associated with negative predictive values of >85% across all treatment groups. CONCLUSIONS NT-proBNP may be a useful marker for anticipating cardiovascular risk associated with the use of antiinflammatory drugs for osteoarthritis.
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Affiliation(s)
- Kay Brune
- Department of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
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Pfister R, Tan D, Thekkanal J, Hellmich M, Schneider CA. NT-pro-BNP is associated with long-term outcome in a heterogeneous sample of cardiac inpatients. Eur J Intern Med 2007; 18:215-20. [PMID: 17449394 DOI: 10.1016/j.ejim.2006.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Revised: 09/22/2006] [Accepted: 11/02/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND B-type natriuretic peptides (NP) are excellent predictors of mortality in selected patients with heart failure and coronary heart disease. Up to now, the association of NPs with cardiovascular outcome has not been evaluated in multi-morbid populations with a broad spectrum of cardiovascular disease. METHODS NT-pro-BNP was measured at discharge in 615 inpatients from a cardiology department of a university hospital. The association of discharge NT-pro-BNP with long-term outcome was examined during a median follow-up time of 1130 days. RESULTS NT-pro-BNP was significantly elevated in patients who died, developed ischemic stroke, or were hospitalized due to acute heart failure, but not in patients who developed myocardial infarction or underwent coronary angioplasty compared to patients without any endpoint. Patients with supramedian NT-pro-BNP values (>339 pg/ml) had significantly worse outcomes with respect to the combined endpoint (CE) of death, heart failure hospitalization, and stroke than patients with inframedian NT-pro-BNP values. After adjusting for age, gender, renal function, NYHA class, presence of diabetes, coronary 3-vessel disease, systolic and valvular dysfunction, NT-pro-BNP was a significant predictor of the CE. The AUC for NT-pro-BNP to predict the CE was 0.79 in the total population, 0.81 in patients with coronary heart disease or acute heart failure, and 0.74 in patients with other diagnoses. A NT-pro-BNP cut-off value of 240 pg/ml revealed a negative predictive value of more than 93% in all three groups. CONCLUSION In a heterogeneous population of hospitalized cardiac patients, NT-pro-BNP measured at discharge predicts a poor cardiovascular outcome, independently of the cardiologic diagnosis and traditional risk factors.
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Affiliation(s)
- Roman Pfister
- Department III of Internal Medicine, University of Cologne, Josef-Stelzmann Str. 9, 50924 Cologne, Germany
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Goetze JP. Coronary artery disease, heart failure, and cardiac natriuretic peptides in the middleThe opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology. Eur Heart J 2005; 26:2603-4. [PMID: 16246827 DOI: 10.1093/eurheartj/ehi614] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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