Abstract 3410: B-type Natriuretic Peptide, Subclinical Atherosclerosis and Prognosis
Intro: B-type Natiuretic Peptide (BNP) has prognostic implications in pts with heart failure. Its prognostic role in asymptomatic pts with subclinical disease remains unclear.
Methods: We studied 2,103 asymptomatic adults (46% women) with avg Framingham risk score (FRS) of 8.6±7% who underwent computed (CT) for coronary artery calcium (CAC). BNP levels were measured by the Triage CardioProfilER panel method (Biosite Inc). Cox proportional hazards model estimated time to any cardiac event (CE)[N=17 (5 deaths, 2 MI, 1 CABG, 11 PCI, 13 obstructive disease)] Receiver operating characteristics curves (ROC) and relative risk (RR) (95% confidence intervals) were calculated.
Results: BNP ≥40 pg/ml was more frequent in pts with CAC < vs. ≥400(9% vs. 20%, p<0.0001). In a multivariable model (MM), factors associated with BNP ≥40 included age (p<0.0001), SBP (p=0.002), LDL-C (p=0.001), and CAC (p=0.008). RR for CE was elevated 4.5– (1.6–3.2) fold in pts. with BNP ≥40 pg/ml (p<0.0001). For CAC ≥400, RR were elevated 33.3– (5.6–199.3) fold (p<0.0001). Both BNP and CACwere predictive of CE in MM adjusting for the FRS. ROC curve area for estimating CE was higher for CAC vs BNP (BNP=0.64 vs. CAC=0.82, p<0.0001). The combination of BNP ≥40 pg/ml and CAC ≥400 identified a high risk subset of pts with a 64.7– (14.4–291.7) fold risk of CE (p<0.0001).
Conc: In this asymptomatic cohort with average FRS, BNP ≥40 pg/ml identified pts with an elevated risk of CE. BNP added prognostic value over CAC, a stronger prognostic variable. These findings suggest that the combination of elevated markers of mechanical stress (BNP) and atherosclerotic disease burden (CAC) identify risk of CE in asymptomatic individuals.