Published Online
on June 27, 2005

A more recent version of this article appeared on July 5, 2005

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Submitted on November 30, 2004
Revised on December 23, 2004
Accepted on March 4, 2005

Prediction of Myocardial Infarction by N-Terminal-Pro-B-Type Natriuretic Peptide, C-Reactive Protein, and Renin in Subjects With Cerebrovascular Disease

Duncan J. Campbell MD, PhD^*, Mark Woodward PhD, John P. Chalmers MD, PhD, Samuel A. Colman MBios, Alicia J. Jenkins MD, Bruce E. Kemp PhD, Bruce C. Neal MD, PhD, Anushka Patel MD, and Stephen W. MacMahon PhD

From St Vincent’s Institute of Medical Research (D.J.C., B.E.K.) and Department of Medicine (D.J.C., A.J.J., B.E.K.), University of Melbourne, St Vincent’s Hospital, Fitzroy, Victoria; CSIRO Health Sciences and Nutrition (B.E.K.), Parkville, Victoria; and The George Institute for International Health (M.W., J.P.C., S.A.C., B.C.N., A.P., S.W.M.), University of Sydney, Camperdown, New South Wales, Australia.

^* To whom correspondence should be addressed. E-mail: dcampbell{at}svi.edu.au.

Background--B-type natriuretic peptide (BNP), C-reactive protein (CRP), and renin are elevated in persons at risk for cardiovascular disease. However, data that directly compare these markers in the prediction of myocardial infarction (MI) are limited.

Methods and Results--N-terminal-proBNP (NT-proBNP), CRP, and renin were measured in baseline blood samples from a nested case-control study of the 6105 participants of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS), a placebo-controlled study of a perindopril-based blood pressure-lowering regimen among individuals with previous stroke or transient ischemic attack. Each of 206 subjects who experienced MI, either fatal or nonfatal, during a mean follow-up of 3.9 years was matched to 1 to 3 control subjects. Most MI cases (67%) occurred in subjects without a history of coronary heart disease. NT-proBNP, CRP, and renin each predicted MI; the odds ratio for subjects in the highest compared with the lowest quarter was 2.2 (95% CI, 1.3 to 3.6) for NT-proBNP, 2.2 (95% CI, 1.3 to 3.6) for CRP, and 1.7 (95% CI, 1.1 to 2.8) for renin. NT-proBNP and renin, but not CRP, remained predictors of MI after adjustment for all other predictors, including LDL and HDL cholesterol levels. Individuals with both NT-proBNP and renin in their highest quarters had 4.5 times the risk of MI compared with subjects with both biological markers in their lowest quarters.

Conclusions--NT-proBNP and renin, but not CRP, are independent predictors of MI risk after stroke or transient ischemic attack, providing information additional to that provided by classic risk factors, and may enable more effective targeting of MI prevention strategies.

Key words: C-reactive protein • myocardial infarction • natriuretic peptides • renin • risk factors

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N-Terminal-Pro-B–Type Natriuretic Peptide: Universal Marker of Cardiovascular Risk?

A. Mark Richards and Christopher M. Frampton
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