Abstract 16978: Midregional Pro-Atrial Natriuretic Peptide and Risk of Recurrent Cardiovascular Disease Events in Patients with Stable Coronary Heart Disease Followed Over 8 Years
Aim: Natriuretic peptides provide valuble information about cardiac dysfunction. The clinical relevance of elevated circulating midregional pro-atrial natriuretic peptide (MR-proANP) in patients with stable coronary heart disease (CHD) several weeks after an acute event has not been fully evaluated. We aimed to assess the predictive value of MR-proANP for recurrent cardiovascular disease (CVD) events in stable CHD patients, simultaneously controlling for a large number of potential confounders.
Methods: Plasma concentrations of MR-proANP (BRAHMS) were measured at baseline in a cohort of 1,048 patients aged 30-70 years with CHD. The Cox proportional hazards model was used to determine the prognostic value of MR-proANP on a combined CVD endpoint after adjustment for covariates.
Results: The median MR-proANP level was 135.2 pmol/L (interquartile range 95.2-185.8). Elevated MR-proANP levels were associated with higher age, obesity, history of hypertension, diabetes, and heart failure, higher number of affected vessels, initial management of CHD, and left-ventricular dysfunction in a statistically significant way. Furthermore, after adjustment for age and gender MR-proANP was correlated with CRP (correlation coefficient (R=0.21), NT-proBNP (R=0.72), creatinine clearance (R= -0.32), cystatin C (R=0.43), hsTnT (R= 0.51) respectively (all p-values <0.0001). During a median follow-up of 8.1 years, 150 patients (21.1%) experienced a fatal- or non-fatal secondary CVD event. In a multivariate model MR-proANP was associated with a hazard ratio (HR) of secondary CVD events of 3.00 (95% confidence interval (CI), 1.70-5.28) when extreme quartiles were compared. Further adjustment for NT-proBNP attenuated the association only slightly (HR 2.67; 95% CI, 1.48-4.79).
Conclusions: Elevated MR-proANP levels in stable CHD patients are associated with several CVD disorders and predict long-term CVD events in these patients.
- © 2011 by American Heart Association, Inc.