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(Circulation. 2009;120:1768-1774.)
© 2009 American Heart Association, Inc.

Arrhythmia/Electrophysiology

N-Terminal Pro-B-Type Natriuretic Peptide Is a Major Predictor of the Development of Atrial Fibrillation

The Cardiovascular Health Study

Kristen K. Patton, MD; Patrick T. Ellinor, MD, PhD; Susan R. Heckbert, MD, PhD; Robert H. Christenson, PhD; Christopher DeFilippi, MD; John S. Gottdiener, MD; Richard A. Kronmal, PhD

From the Division of Cardiology (K.K.P.), Department of Epidemiology (S.R.H.), and Department of Biostatistics (R.A.K.), University of Washington, Seattle; Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.T.E.); University of Maryland School of Medicine, Baltimore (R.H.C.); and Division of Cardiology, University of Maryland Medical Center, Baltimore (C.D., J.S.G.).

Correspondence to Richard A. Kronmal, PhD, Collaborative Health Studies Coordinating Center, University of Washington, Bldg 29, Suite 310, 6200 NE 74th St, Seattle, WA 98115. E-mail kronmal{at}u.washington.edu

Received April 20, 2009; accepted July 31, 2009.

Background— Atrial fibrillation (AF), the most common cardiac rhythm abnormality, is associated with significant morbidity, mortality, and healthcare expenditures. Elevated B-type natriuretic peptide levels have been associated with the risk of heart failure, AF, and mortality.

Methods and Results— The relation between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and AF was studied in 5445 Cardiovascular Health Study participants with the use of relative risk regression for predicting prevalent AF and Cox proportional hazards for predicting incident AF. NT-proBNP levels were strongly associated with prevalent AF, with an unadjusted prevalence ratio of 128 for the highest quintile (95% confidence interval, 17.9 to 913.3; P<0.001) and adjusted prevalence ratio of 147 for the highest quintile (95% confidence interval, 20.4 to 1064.3; P<0.001) compared with the lowest. After a median follow-up of 10 years (maximum of 16 years), there were 1126 cases of incident AF (a rate of 2.2 per 100 person-years). NT-proBNP was highly predictive of incident AF, with an unadjusted hazard ratio of 5.2 (95% confidence interval, 4.3 to 6.4; P<0.001) for the development of AF for the highest quintile compared with the lowest; for the same contrast, NT-proBNP remained the strongest predictor of incident AF after adjustment for an extensive number of covariates, including age, sex, medication use, blood pressure, echocardiographic parameters, diabetes mellitus, and heart failure, with an adjusted hazard ratio of 4.0 (95% confidence interval, 3.2 to 5.0; P<0.001).

Conclusions— In a community-based population of older adults, NT-proBNP was a remarkable predictor of incident AF, independent of any other previously described risk factor.

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Clinical Summaries
Circulation 2009 120: 1743-1744. [Extract] [Full Text]