Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
Arterioscler Thromb Vasc Biol. 2011 Dec;31(12):2997-3003. doi: 10.1161/ATVBAHA.111.223669. Epub 2011 Sep 15.
Few studies have examined the association between natriuretic peptides and the incidence of cardiovascular disease (CVD) in Asian populations.
A total of 3104 community-dwelling Japanese individuals aged ≥40 years without history of CVD were followed up for 5 years. A total of 127 CVD events were identified. The age- and sex-adjusted incidence of CVD increased with increasing N-terminal pro-brain natriuretic peptide (NT-proBNP) levels (<55, 55-124, 125-399, and ≥400 pg/mL) at baseline and was significantly higher even in subjects with a modest increase. This association remained robust even after adjustment for other potential risk factors (55-124 pg/mL: multivariate-adjusted hazard ratio=1.85 [95% CI 1.07-3.18], P=0.03; 125-399 pg/mL: 2.98 [95% CI 1.65-5.39], P<0.001; ≥400 pg/mL: 4.54 [95% CI 2.22-9.29], P<0.001). The multivariate-adjusted hazard ratios for the development of total CVD and its subtypes, coronary heart disease and stroke, were significantly increased by a 1 SD increment of the log NT-proBNP concentrations and were nearly equal among CVD subtypes. Similar findings were observed for stroke subtypes of ischemic stroke and intracerebral hemorrhage but not subarachnoid hemorrhage. The effects of the 1 SD increment in log NT-proBNP values were comparable in subjects with and without other cardiovascular risk factors, except for sex. The area under the receiver operating characteristic curve was significantly (P=0.006) increased by adding NT-proBNP values to the model including other potential risk factors.
Elevated NT-proBNP levels were shown to be a significant risk factor for the development of CVD and its subtypes in a general Japanese population, independently of other cardiovascular risk factors.
很少有研究探讨亚洲人群中心钠肽与心血管疾病（CVD）发病率之间的关系。
共纳入 3104 名年龄≥40 岁、无 CVD 病史的社区居民，随访 5 年。共确定 127 例 CVD 事件。年龄和性别调整后，CVD 的发病率随基线时 N 端脑利钠肽前体（NT-proBNP）水平升高而增加（<55、55-124、125-399 和≥400 pg/ml），且即使在轻度升高的患者中，发病率也显著升高。即使在调整其他潜在危险因素后，这种相关性仍然很强（55-124 pg/ml：多变量调整的危险比=1.85[95%CI 1.07-3.18]，P=0.03；125-399 pg/ml：2.98[95%CI 1.65-5.39]，P<0.001；≥400 pg/ml：4.54[95%CI 2.22-9.29]，P<0.001）。NT-proBNP 浓度的自然对数值每增加 1 SD，总 CVD 及其各亚型（冠心病和中风）的多变量调整后的危险比显著增加，且各 CVD 亚型之间几乎相等。这种相关性也见于缺血性中风和脑出血的中风亚型，但蛛网膜下腔出血除外。在有或无其他心血管危险因素的患者中，log NT-proBNP 值增加 1 SD 的影响相当，除性别外。与不包括其他潜在危险因素的模型相比，将 NT-proBNP 值添加到包括其他潜在危险因素的模型中，可显著提高接受者操作特征曲线下的面积（P=0.006）。
在一般日本人群中，升高的 NT-proBNP 水平是 CVD 及其各亚型发展的一个重要危险因素，独立于其他心血管危险因素。
