Abstract 948: Brain Natriuretic Peptide Levels Predict Cardiovascular Outcome in Patients with Peripheral Arterial Disease
Background: Systemic levels of brain natiuretic peptide (BNP) have been reported to predict clinical outcome in patients with atherosclerotic coronary artery disease. This study investigated the relationship between BNP levels and cardiovascular events in patients with an established history of peripheral arterial disease (PAD).
Methods: Patients with a history of PAD were identified from a cohort presenting for a clinically indicated coronary angiogram. The relationship between baseline BNP levels and incidence of death, myocardial infarction, stroke and revascularization over the next 3 years was determined.
Results: 819 patients with PAD (age 67.3 years, 64.3% male, 39.8% diabetes, 85.5% hyperlipidemia, 79.8% hypertension, 84.7% coronary artery disease and 26.2% heart failure) were identified. Patients had a Framingham Risk Score 8.0, left ventricular ejection fraction 49.4% and Duke Angiographic Score 52.7. Biochemistry included median BNP 168.7 pg/mL, CRP 3.5 mg/L and creatinine 0.9 mg/dL. Significant correlations were observed between levels of BNP and both CRP (r=0.33, p<0.001) and creatinine (r=0.22, p<0.001). A direct relationship was observed between levels of BNP and incidence of death, MI or stroke during 3 year follow-up (12.4%, 18.7%, 21.8% and 39.3% with increasing BNP quartiles, p<0.001). Cox regression analysis, controlling for Framingham risk, creatinine clearance and history of heart failure, revealed that increasing levels of BNP were associated with an incremental risk of cardiovascular events (Hazard Ratio 1.42 (95% confidence interval [1.16–1.74], p=0.001 for each SD increase in BNP).
Conclusion: Increasing systemic levels of BNP predict cardiovascular outcome in high risk patients with a history of PAD presenting for clinically indicated coronary angiography. This suggests that BNP levels may provide prognostic utility in patients with PAD and further highlights the potential role of BNP in the development of atherosclerotic cardiovascular disease.