Division of Cardiology, Department of Medicine, University of California at San Diego, USA.
Am J Med. 2011 Jul;124(7):670.e1-8. doi: 10.1016/j.amjmed.2011.02.027.
Natriuretic peptides have prognostic value across a wide spectrum of cardiovascular diseases and may predict cognitive dysfunction in patients with cardiovascular disease, even in the absence of previous stroke. Little is known about the association of natriuretic peptides with cognitive function in community-dwelling adults. We assessed the association between N-terminal pro B-type natriuretic peptide (NT-proBNP) levels and cognitive function in community-dwelling ambulatory older adults in the Rancho Bernardo Study.
We studied 950 men and women, aged 60 years and older, who attended a research clinic visit where a medical history and examination were performed, and blood for cardiovascular disease risk factors and NT-proBNP levels were obtained. Three cognitive function tests were administered: the Mini Mental State Examination (MMSE), Trail-Making Test B (Trails B), and Category Fluency.
Participants with high NT-proBNP levels (≥450 pg/mL; n=198) were older and had a higher prevalence of coronary heart disease (12% vs 30%), and stroke (5% vs 11%; P≤.001 for both). In unadjusted analyses, all 3 cognitive function test scores were significantly associated with NT-proBNP levels (P<.001). After adjusting for age, sex, education, hypertension, body mass index, exercise, alcohol use, smoking, low density lipoprotein cholesterol, creatinine clearance, and previous cardiovascular disease, elevated NT-proBNP levels remained independently associated with poor cognitive performance on MMSE (odds ratio [OR] 2.0; 95% confidence interval [CI], 1.1-3.6; P=.02) and Trails B (OR 1.7; 95% CI, 1.2-2.7; P=.01), but not Category Fluency (OR 1.4; 95% CI, 0.9-2.2; P=.19). Results were unchanged after excluding the 6% of participants with a history of stroke.
NT-proBNP levels were strongly and independently associated with poor cognitive function in community-dwelling older adults.
利钠肽在广泛的心血管疾病谱中具有预后价值，甚至在没有先前中风的情况下，也可预测心血管疾病患者的认知功能障碍。关于利钠肽与社区居住的成年人认知功能之间的关系知之甚少。我们评估了 N 末端 B 型利钠肽前体（NT-proBNP）水平与 Rancho Bernardo 研究中社区居住的活动老年人认知功能之间的关系。
我们研究了 950 名年龄在 60 岁及以上的男性和女性，他们参加了研究诊所就诊，进行了病史和检查，并采集了心血管疾病危险因素和 NT-proBNP 水平的血液。进行了 3 项认知功能测试：简易精神状态检查（MMSE），Trail-Making 测试 B（Trails B）和类别流畅性。
NT-proBNP 水平较高（≥450pg/ml；n=198）的参与者年龄较大，且冠心病（12%比 30%）和中风（5%比 11%；均 P≤.001）的患病率较高。在未调整的分析中，所有 3 项认知功能测试评分均与 NT-proBNP 水平显著相关（P<.001）。调整年龄，性别，教育程度，高血压，体重指数，运动，饮酒，吸烟，低密度脂蛋白胆固醇，肌酐清除率和先前的心血管疾病后，升高的 NT-proBNP 水平仍与 MMSE 认知表现差独立相关（优势比[OR]2.0；95%置信区间[CI]，1.1-3.6；P=.02）和 Trails B（OR 1.7；95% CI，1.2-2.7；P=.01），但与类别流畅性无关（OR 1.4；95% CI，0.9-2.2；P=.19）。排除了 6%有中风病史的参与者后，结果保持不变。
NT-proBNP 水平与社区居住的老年人认知功能差密切相关且独立相关。
