Abstract 13793: B-Type Natriuretic Peptide: Age and Gender Specific for Risk Stratification in the General Population - The Heinz Nixdorf Recall Study

Abstract

Background: Elevated B-type natriuretic peptide (BNP) levels predict risk for cardiovascular (CV) events in the general population above traditional risk factors. To date, age and gender specific BNP-thresholds that indicate an increased risk for CV events have not been established beyond the threshold of 100pg/ml in heart failure patients.

Objective: We determine age and gender specific 90^th BNP-percentile in a general population and evaluate the association of elevated BNP levels according to this threshold with incident major CV events.

Methods: In a first step, we determined the age and gender specific 90^th percentiles of BNP in participants from the Heinz Nixdorf Recall Study without prevalent CV disease (i.e. myocardial infarction, stroke, atrial fibrillation, or revascularization), known hypertension or chronic renal failure (GFR < 60 mL/min) as known determinants of increased BNP. Consecutively, the association elevated BNP levels according to this threshold with major CV events (myocardial infarction, stroke, or cardiovascular death) was assessed in the entire cohort using cox regression analysis.

Results: At baseline 1639 subjects had no hypertension, CKD or CV disease. In this subgroup, the age and gender specific 90^th percentile of BNP was as follows: male: 45-54: 22.7; 55-64: 35.6; 65-75: 47.2 (all pg/ml); female: 45-54: 38.3; 55-64: 46.0; 65-75: 62.5 (all pg/ml). From overall 3785 subjects (mean age 59.5, 52.1% female), 211 subjects developed a major CV event during a mean follow-up period of 8.0 ± 1.5 years. Subjects with BNP levels above the determined thresholds had increased incidence of major CV events (9.4% for BNP > 90^th percentile vs. 4.9% for BNP ≤ 90^th, p<0.001). This effect persisted in regression analysis when adjusting for traditional risk factors (hazard ratio (95% confidence interval): 1.6 (1.1-2.2), p=0.008).

Conclusion: The age and gender specific 90^th percentile of BNP obtained from a general population cohort, aged 45-75 years without hypertension, CKD and CV disease is associated with major CV events, suggesting that even lower BNP-thresholds than 100pg/ml could improve primary risk prediction in the general population.