Abstract 17770: Utility of Plasma B-Type Natriuretic Peptide Levels for Cardiovascular Risk Assessment in Subjects with Albuminuria
Background: The subjects with albuminuria is a high risk group for cardiovascular disease (CVD). Also, increased plasma B-type natriuretic peptide (BNP) levels have been reported to be associated with CVD risk in several clinical and population-based settings. However, it remains unknown whether CVD risk in subjects with albuminuria could be stratified by plasma BNP levels.
METHODS: At baseline, we measured spot urinary albumin/creatinine concentrations (UACR) and plasma BNP concentration in the general population (n = 15,344). Albuminuria was defined by UACR more than 30 mg/g creatinine (Cr). Data from 3,214 subjects aged 40 to 80 (mean age = 65 years) with no cardiovascular history were analyzed. The cohort was divided into quartiles according to plasma BNP, and the CVD event free rate within each BNP quartile was estimated using the Kaplan-Meier method. In addition, Cox regression analysis was performed to examine the relative risk of onset of CVD events among the quartiles.
RESULTS: The mean follow-up duration was 5.7 years. Cases admitted for CVD events (heart failure, stroke, myocardial infarction) in the cohort were surveyed prospectively. The event free rate of the highest BNP quartile showed the lowest event free ratio (p < 0.001). After adjustment for established CVD risk factors including glycosylated hemoglobin (HbA1c) values and estimated glomerular filtration rate (eGFR), the hazard ratio (HR) for CVD events increased significantly according to BNP quartile (p for trend < 0.001), and the HR for the highest BNP quartile was significantly elevated compared to that for the lowest quartile (HR = 2.43, 95% CI; 1.44 - 4.09: Figure). When subjects with diabetes or reduced eGFR (<60) were excluded, the association remained to be robust (Figure).
CONCLUSION: Elevated plasma BNP levels are a useful biomarker for CVD risk stratification in subjects with albuminuria independent of classical risk factors including diabetes or renal dysfunction.
- © 2011 by American Heart Association, Inc.