Abstract 12583: The Predictive Utility of Circulating C-Type Natriuretic Peptide for Myocardial Infarction and Heart Failure in the General Population
Background: C-type natriuretic peptide (CNP) is an endothelial cell derived 22 amino acid peptide. Previous studies have reported that CNP is a coronary vasodilator as well as possesses anti-atherogenic and pro-angiogenic properties, underscoring a vascular protective role for CNP. Notably, advanced human coronary atherosclerotic lesions have robust CNP positive cells, suggesting CNP activation may represent both a protective response as well as a marker of coronary injury. To date, no studies have evaluated plasma CNP or the prognostic value of CNP, in the general population.
Hypothesis: We hypothesized that CNP circulates in subjects from the general population and will have significant prognostic value for myocardial infarction (MI) and its sequelae heart failure (HF).
Methods: Our cohort (n=1,841) was a random sample of adult subjects (mean age 62±11yrs, 48% male) from Olmsted County, MN. Subjects had a clinical examination and plasma CNP was measured. Subjects were followed for MI, HF and death over 12 yrs. Hazard ratios (HRs) for CNP in the highest quartile (compared to lower three quartiles) were calculated. Statistical significance: P≤0.05.
Results: Median (Q1,Q3) plasma CNP was 13.2 (10.2, 16.8) pg/ml and levels were not affected by age or sex. Highest quartile of CNP corresponded to values of >16.8 pg/ml. Over the 12 yr follow-up,189 MI, 232 HF and 328 deaths were recorded. Unadjusted HRs demonstrated that highest CNP has prognostic significance for MI, HF and death (HRs 1.88, 95% CI 1.40-2.51; 1.76, 95% CI 1.35-2.30 and 1.41, 95% CI 1.12-1.78, respectively). Adjustment for traditional risk factors (i.e. age,sex,BMI,cholesterol,creatinine,smoking, presence of diabetes,coronary artery disease and hypertension) and plasma NT-proBNP, highest CNP retained prognostic significance for MI and HF (HRs 1.56, 95% CI 1.14-2.13 and 1.37, 95% CI 1.03-1.81 respectively),but not death.
Conclusions: We report for the first time that plasma CNP may represent a novel endothelium-derived biomarker that has prognostic significance for MI and HF, beyond traditional risk factors and NT-proBNP, in the general population. These findings have important implications for identifying subjects at high risk and the implementation of early preventative strategies.
- © 2013 by American Heart Association, Inc.