Division of Cardiology, Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
J Am Coll Cardiol. 2010 Feb 2;55(5):441-50. doi: 10.1016/j.jacc.2009.07.069.
This study sought to determine whether serial measurement of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in community-dwelling elderly people would provide additional prognostic information to that from traditional risk factors.
Accurate cardiovascular risk stratification is challenging in elderly people.
NT-proBNP was measured at baseline and 2 to 3 years later in 2,975 community-dwelling older adults free of heart failure in the longitudinal CHS (Cardiovascular Health Study). This investigation examined the risk of new-onset heart failure (HF) and death from cardiovascular causes associated with baseline NT-proBNP and changes in NT-proBNP levels, adjusting for potential confounders.
NT-proBNP levels in the highest quintile (>267.7 pg/ml) were independently associated with greater risks of HF (hazard ratio [HR]: 3.05; 95% confidence interval [CI]: 2.46 to 3.78) and cardiovascular death (HR: 3.02; 95% CI: 2.36 to 3.86) compared with the lowest quintile (<47.5 pg/ml). The inflection point for elevated risk occurred at NT-proBNP 190 pg/ml. Among participants with initially low NT-proBNP (<190 pg/ml), those who developed a >25% increase on follow-up to >190 pg/ml (21%) were at greater adjusted risk of HF (HR: 2.13; 95% CI: 1.68 to 2.71) and cardiovascular death (HR: 1.91; 95% CI: 1.43 to 2.53) compared with those with sustained low levels. Among participants with initially high NT-proBNP, those who developed a >25% increase (40%) were at higher risk of HF (HR: 2.06; 95% CI: 1.56 to 2.72) and cardiovascular death (HR: 1.88; 95% CI: 1.37 to 2.57), whereas those who developed a >25% decrease to <or=190 pg/ml (15%) were at lower risk of HF (HR: 0.58; 95% CI: 0.36 to 0.93) and cardiovascular death (HR: 0.57; 95% CI: 0.32 to 1.01) compared with those with unchanged high values.
NT-proBNP levels independently predict heart failure and cardiovascular death in older adults. NT-proBNP levels frequently change over time, and these fluctuations reflect dynamic changes in cardiovascular risk.
本研究旨在确定在社区居住的老年人中连续测量 N 末端 B 型利钠肽前体（NT-proBNP）是否会提供比传统危险因素更多的预后信息。
在老年人中准确进行心血管风险分层具有挑战性。
在无心力衰竭的 2975 名社区居住的老年人中，在纵向 CHS（心血管健康研究）中，在基线时和 2 至 3 年后测量 NT-proBNP。本研究通过调整潜在混杂因素，检测与基线 NT-proBNP 相关的新发心力衰竭（HF）和心血管原因死亡的风险，以及 NT-proBNP 水平的变化。
与最低五分位数（<47.5 pg/ml）相比，最高五分位数（>267.7 pg/ml）的 NT-proBNP 水平与 HF（风险比[HR]：3.05；95%置信区间[CI]：2.46 至 3.78）和心血管死亡（HR：3.02；95%CI：2.36 至 3.86）的风险增加独立相关。风险升高的拐点发生在 NT-proBNP 190 pg/ml 时。在最初 NT-proBNP 水平较低（<190 pg/ml）的参与者中，那些在随访期间升高幅度超过 25%至>190 pg/ml（21%）的患者，HF（HR：2.13；95%CI：1.68 至 2.71）和心血管死亡（HR：1.91；95%CI：1.43 至 2.53）的风险更高，而那些 NT-proBNP 水平持续较低的患者风险则较低。在最初 NT-proBNP 水平较高的参与者中，那些升高幅度超过 25%（40%）的患者 HF（HR：2.06；95%CI：1.56 至 2.72）和心血管死亡（HR：1.88；95%CI：1.37 至 2.57）的风险更高，而那些升高幅度超过 25%至<或=190 pg/ml（15%）的患者 HF（HR：0.58；95%CI：0.36 至 0.93）和心血管死亡（HR：0.57；95%CI：0.32 至 1.01）的风险较低，而那些 NT-proBNP 值保持较高的患者风险则较高。
NT-proBNP 水平可独立预测老年人的心力衰竭和心血管死亡。NT-proBNP 水平随时间频繁变化，这些波动反映了心血管风险的动态变化。
