Abstract 1681: Pro-B-type Natriuretic Peptide: A Novel Cardiac Biomarker Predicts Death and Cardiovascular Events in the General Community: An 11-Year Follow-up Study in Olmsted County, MN
Introduction: Pro-B-type Natriuretic Peptide (ProBNP) is a 108-amino acid peptide produced by the heart and cleaved into active B-type natriuretic peptide (BNP) and inactive NT-proBNP. Recently, we have used a novel, highly-specific assay for ProBNP which does not detect BNP or NT-proBNP and determined that ProBNP circulates in all humans and may be the predominant BNP form in heart failure (HF). To date, the predictive value of plasma ProBNP as a biomarker for future cardiovascular (CV) events and death in the general community is undefined. We hypothesized that ProBNP will predict death and future CV events in the general population.
Methods: Our retrospective cohort (n=2042) was a random sample of Olmsted County, MN, residents 45 years old or older. Each subject had clinical examination, 2-D Doppler Echo, and measurement of plasma ProBNP (BioRad) on two separate visits, one each within a year of 1999 and 2003. We used electronic records to assess death or diagnosis of CV events (MI, Stroke, CHF, and atrial fibrillation [AF]). Univariate and multivariable time-to-event analyses determined the associations between plasma ProBNP, clinical or cardiac variables, and survival free of death or CV events. We also report the causes of and associations with death for an 11-year follow-up on our cohort.
Results: Over an 11-year follow-up period, ProBNP (upper quartile compared to lower quartile) was significantly associated with mortality (OR 6.97, p<.001), and remained associated with mortality independent of age, gender, BMI, and left ventricular hypertrophy (2.17, p=.002). ProBNP was significantly associated with a composite endpoint of MI, stroke, or HF independent of other variables (2.16, p<.001). ProBNP was also an independent predictor of AF (2.58, p<.001).
Conclusions: We conclude that ProBNP is a robust predictor of both death and future CV events in the general community over 11 years. Thus, ProBNP may be used to determine who in the general population is at the highest CV risk and requires more aggressive primary prevention. Importantly, the biological implication is that while ProBNP is present in normal plasma, there may be cardiac overproduction of ProBNP or a lack of peripheral processing of ProBNP either concomitant with or responsible for CV disease.
This research has received full or partial funding support from the American Heart Association, Midwest Affiliate (Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, South Dakota & Wisconsin).