Wang Thomas J, Larson Martin G, Levy Daniel, Benjamin Emelia J, Leip Eric P, Omland Torbjorn, Wolf Philip A, Vasan Ramachandran S
Framingham Heart Study, Framingham, MA 01702-5827, USA.
N Engl J Med. 2004 Feb 12;350(7):655-63. doi: 10.1056/NEJMoa031994.
The natriuretic peptides are counterregulatory hormones involved in volume homeostasis and cardiovascular remodeling. The prognostic significance of plasma natriuretic peptide levels in apparently asymptomatic persons has not been established.
We prospectively studied 3346 persons without heart failure. Using proportional-hazards regression, we examined the relations of plasma B-type natriuretic peptide and N-terminal pro-atrial natriuretic peptide to the risk of death from any cause, a first major cardiovascular event, heart failure, atrial fibrillation, stroke or transient ischemic attack, and coronary heart disease.
During a mean follow-up of 5.2 years, 119 participants died and 79 had a first cardiovascular event. After adjustment for cardiovascular risk factors, each increment of 1 SD in log B-type natriuretic peptide levels was associated with a 27 percent increase in the risk of death (P=0.009), a 28 percent increase in the risk of a first cardiovascular event (P=0.03), a 77 percent increase in the risk of heart failure (P<0.001), a 66 percent increase in the risk of atrial fibrillation (P<0.001), and a 53 percent increase in the risk of stroke or transient ischemic attack (P=0.002). Peptide levels were not significantly associated with the risk of coronary heart disease events. B-type natriuretic peptide values above the 80th percentile (20.0 pg per milliliter for men and 23.3 pg per milliliter for women) were associated with multivariable-adjusted hazard ratios of 1.62 for death (P=0.02), 1.76 for a first major cardiovascular event (P=0.03), 1.91 for atrial fibrillation (P=0.02), 1.99 for stroke or transient ischemic attack (P=0.02), and 3.07 for heart failure (P=0.002). Similar results were obtained for N-terminal pro-atrial natriuretic peptide.
In this community-based sample, plasma natriuretic peptide levels predicted the risk of death and cardiovascular events after adjustment for traditional risk factors. Excess risk was apparent at natriuretic peptide levels well below current thresholds used to diagnose heart failure.
利钠肽是参与容量稳态和心血管重塑的反调节激素。血浆利钠肽水平在明显无症状者中的预后意义尚未确立。
我们对3346例无心力衰竭的患者进行了前瞻性研究。使用比例风险回归分析，我们研究了血浆B型利钠肽和N末端前心房利钠肽与任何原因导致的死亡风险、首次重大心血管事件、心力衰竭、心房颤动、中风或短暂性脑缺血发作以及冠心病风险之间的关系。
在平均5.2年的随访期间，119名参与者死亡，79人发生了首次心血管事件。在对心血管危险因素进行调整后，log B型利钠肽水平每增加1个标准差，死亡风险增加27%（P = 0.009），首次心血管事件风险增加28%（P = 0.03），心力衰竭风险增加77%（P < 0.001），心房颤动风险增加66%（P < 0.001），中风或短暂性脑缺血发作风险增加53%（P = 0.002）。肽水平与冠心病事件风险无显著相关性。B型利钠肽值高于第80百分位数（男性为20.0 pg/ml，女性为23.3 pg/ml）与多变量调整后的死亡风险比为1.62（P = 0.02）、首次重大心血管事件风险比为1.76（P = 0.03）、心房颤动风险比为1.91（P = 0.02）、中风或短暂性脑缺血发作风险比为1.99（P = 0.02）以及心力衰竭风险比为3.07（P = 0.002）相关。N末端前心房利钠肽也得到了类似结果。
在这个基于社区的样本中，血浆利钠肽水平在对传统危险因素进行调整后可预测死亡和心血管事件风险。在远低于目前用于诊断心力衰竭的阈值的利钠肽水平时，额外风险就已明显。
