Published online before print May 26, 2009, doi: 10.1161/CIRCULATIONAHA.108.832576
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2009;119:2868-2876.)
© 2009 American Heart Association, Inc.
Arrhythmia/Electrophysiology |
Amino-Terminal Pro-B-Type Natriuretic Peptide and High-Sensitivity C-Reactive Protein as Predictors of Sudden Cardiac Death Among Women
From the Cardiovascular Division, Massachusetts General Hospital, Boston (E.K., J.L.J.); Center for Arrhythmia Prevention (C.M.A., M.V.M.), Division of Preventive Medicine (C.M.A., N.R.C., M.V.M.), and Cardiovascular Division (C.M.A.), Brigham and Women’s Hospital and Department of Medicine, Harvard Medical School, Boston, Mass; and Siemens Healthcare Diagnostics Inc, Newark, Del (M.L.G.).
Correspondence to Dr Christine Albert, Center for Arrhythmia Prevention, Division of Preventive Medicine and Cardiovascular Division, Brigham and Women’s Hospital, 900 Commonwealth Ave E, Boston, MA 02215–1204. E-mail calbert{at}partners.org
Received November 8, 2008; accepted March 16, 2009.
Background— Plasma concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP) have been found to predict risk of sudden cardiac death (SCD) in patients with known cardiac disease, and C-reactive protein levels have been found to predict risk among apparently healthy men. However, there are no data on SCD risk prediction for either of these markers in a population of women unselected on the basis of cardiovascular disease.
Methods and Results— In a prospective, nested, case-control analysis within the 121 700-participant Nurses’ Health Study, 99 cases of definite or probable SCD were identified and matched to 294 controls. In multivariable models that adjusted for coronary heart disease risk factors, glomerular filtration rate, and other biomarkers, the trend across quartiles approached significance for NT-proBNP (rate ratio=2.37 for comparison of the highest and lowest quartile; P for trend=0.05) but not for high-sensitivity C-reactive protein (P for trend=0.60). When examined continuously, both NT-proBNP and high-sensitivity C-reactive protein were significantly associated with SCD risk in age- and fasting-adjusted models (P for linear trend=0.04 and 0.03). Adjustment for coronary heart disease risk factors and other biomarkers strengthened the relationship with NT-proBNP and SCD (relative risk for 1-SD increment=1.49; 95% confidence interval, 1.09 to 2.05; P=0.01) but eliminated the relationship with high-sensitivity C-reactive protein (P=0.34). Women with NT-proBNP levels above the prespecified cut point of 389 pg/mL were at a markedly increased risk of SCD in both models (rate ratio=5.68; 95% confidence interval, 1.78 to 18.2; P=0.003).
Conclusions— In this population of women, baseline levels of NT-proBNP were associated with subsequent risk of SCD. If this association is confirmed in larger prospectively studied populations, these findings might provide another useful marker contributing to efforts to screen and prevent SCD among women.
CLINICAL PERSPECTIVE
Related Articles:
-
Circulation: Clinical Summaries
Circulation 2009 119: 2861-2862.[Extract] [Full Text]
- Predicting Sudden Death in the General Population: Another Step, N Terminal B-Type Natriuretic Factor Levels
- Sumeet S. Chugh and Kyndaron Reinier
Circulation 2009 119: 2863-2864.[Extract] [Full Text]
This article has been cited by other articles:
 |
|
 |
|
  S. S. Chugh and K. Reinier Predicting Sudden Death in the General Population: Another Step, N Terminal B-Type Natriuretic Factor Levels Circulation, June 9, 2009; 119(22): 2863 - 2864. [Full Text] [PDF]
|
|