Abstract 20861: B-type Natriuretic Peptide and C-Reactive Protein as Markers of Coronary Atherosclerosis
Purpose: The use of high-sensitivity C-reactive protein (CRP) and B-type natriuretic peptide (BNP) as risk markers of coronary atherosclerosis are uncertain in patients with prior coronary artery disease (CAD) or extensive risk factor modification. We sought to determine the clinical benefit of using these biomarkers in an unselected population undergoing diagnostic angiography [the Alternative Risk Markers in Coronary Artery Disease (ARM-CAD) study].
Methods: 468 participants without prior coronary bypass surgery were assessed according to the presence/severity of angiographic CAD using a stenosis score weighted for the impact on usual coronary blood flow. Blood samples, risk factor data and radial artery pulse wave analysis (to derive central blood pressures [BP]) were obtained prior to angiography.
Results: Mean age ± SD was 64 ± 11, BP 144/80 ± 21/10, 65% were male, 21% had diabetes, 44% had prior angina or myocardial infarction and 16% had impaired left-ventricular (LV) function. CRP was unrelated to the severity of CAD (see table). In comparison, there was a linear increase in BNP with the severity of CAD (p for trend<0.0001). However, patients with minor coronary stenoses (30-50%) had elevated BNP levels compared to those with normal coronaries or single vessel CAD (p<0.03), perhaps relating to coronary plaque stability. Multivariate regression, adjusted for risk factors, LV impairment and medications, determined that BNP was an independent marker of the presence of CAD. This association was not significant when including derived central pressures, suggesting that augmentation of central BP may be part of the mechanism for BNP increase in patients with CAD.
Conclusions: BNP is associated with the presence and severity of angiographic disease, irrespective of LV impairment. Our data suggest that in patients with coronary atherosclerosis, BNP may be a marker of ventricular wall tension and neurohormonal activation secondary to changes in central BP.
- © 2010 by American Heart Association, Inc.