Abstract 3678: Prognostic Value of N-terminal pro-BNP in Apparently Healthy Older Adults: Results from the Rancho Bernardo Study
Background: N-terminal pro B-type natriuretic peptide (N-BNP) levels have clinical utility in many venues but their long-term prognostic value in apparently healthy older adults is unknown. The purpose of this study was to determine the prognostic value of N-BNP in a population of community-dwelling elderly adults, and to see whether cardiac troponin T (TnT) improves prognostication.
Methods: Prospective community-based study of 375 men and 584 women ages 60 to 97 (mean 77) who had plasma N-BNP and TnT measurements (Roche Diagnostics) at baseline (1997–99) and were followed for mortality through July 2006. Cox proportional hazards regressions were used to examine the association of N-BNP with mortality; high N-BNP was defined as ≥500 pg/ml (n=177). HR’s are per log N-BNP increase.
Results: N-BNP levels were higher in women than men (p<0.001) and increased with age (r=0.51, p<0.001). During an average follow-up of 6.3 years, 220 deaths occurred; 42% were cardiovascular (CV). Elevated N-BNP predicted an increased risk of all-cause and CV mortality, which persisted after adjusting for age, sex, lifestyle characteristics, and multiple CV risk factors (HR 2.0, p<0.001 for all-cause mortality; HR 2.8, p<0.001 for CV death). In the 808 subjects without known heart disease at baseline, N-BNP levels were still independently associated with mortality and CV death (HR 1.9, p=0.001 and HR 2.0, p=0.04 respectively). Those with both elevated N-BNP levels and detectable TnT levels had poorer survival (HR 7.7 vs low N-BNP, p<0.001) (Figure⇓).
Conclusions: Elevated N-BNP levels independently predict death in apparently healthy individuals; prognostic ability is improved by incorporating TnT.