Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD.
Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Am J Med. 2022 Dec;135(12):1461-1467. doi: 10.1016/j.amjmed.2022.07.012. Epub 2022 Aug 23.
It remains unclear whether elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) can serve as a "risk equivalent" for cardiovascular disease to adults at high cardiovascular risk.
We included 9789 participants (mean age 63.2 years, 55% women, 19.4% Black, 13% with a history of cardiovascular disease) who attended Atherosclerosis Risk in Communities Study Visit 4 (1996-1998). We classified participants as having a history of cardiovascular disease at baseline and, among those without cardiovascular disease, we defined categories of NT-proBNP (<125, 125-449, ≥450 pg/mL). We used Cox regression to estimate associations of NT-proBNP with incident cardiovascular disease and mortality.
Over a median 20.5 years of follow-up, there were 4562 deaths (917 cardiovascular deaths). There were 2817 first events and 806 recurrent events (in those with a history of cardiovascular disease at baseline). Among individuals without a history of cardiovascular disease, those adults with NT-proBNP ≥450 pg/mL had significantly higher risks of all-cause death (hazard ratio [HR] 2.12; 95% confidence interval [CI], 1.78-2.53), cardiovascular mortality (HR 2.92; 95% CI, 2.15-3.97), incident total cardiovascular disease (HR 2.59; 95% CI, 2.13-3.16), atherosclerotic cardiovascular disease (HR 2.20; 95% CI, 1.72-2.80), and heart failure (HR 3.81; 95% CI, 3.01-4.81), compared with individuals with NT-proBNP <125 pg/mL. The elevated cardiovascular risk in persons with high NT-proBNP and no history of cardiovascular disease was similar to, or higher than, the risk conferred by a history of cardiovascular disease.
Our findings suggest that it might be appropriate to manage adults with NT-proBNP ≥450 pg/mL as if they had a history of clinical cardiovascular disease.
目前尚不清楚升高的 N 末端脑利钠肽前体（NT-proBNP）是否可以作为心血管疾病的“风险等效物”，用于处于高心血管风险的成年人。
我们纳入了 9789 名参与者（平均年龄 63.2 岁，55%为女性，19.4%为黑人，13%有心血管疾病史），他们参加了动脉粥样硬化风险社区研究访问 4（1996-1998 年）。我们将基线时有心血管疾病史的参与者归类为患有心血管疾病，并在无心血管疾病的参与者中，将 NT-proBNP 划分为以下几类（<125、125-449、≥450 pg/mL）。我们使用 Cox 回归来估计 NT-proBNP 与心血管疾病和死亡率的发生之间的关联。
在中位数为 20.5 年的随访期间，共有 4562 人死亡（917 人死于心血管疾病）。发生了 2817 例首发事件和 806 例复发性事件（在基线时有心血管疾病史的参与者中）。在没有心血管疾病史的参与者中，NT-proBNP≥450 pg/mL 的成年人全因死亡风险显著增加（风险比[HR]2.12；95%置信区间[CI]，1.78-2.53）、心血管死亡率（HR 2.92；95%CI，2.15-3.97）、新发总心血管疾病（HR 2.59；95%CI，2.13-3.16）、动脉粥样硬化性心血管疾病（HR 2.20；95%CI，1.72-2.80）和心力衰竭（HR 3.81；95%CI，3.01-4.81），与 NT-proBNP<125 pg/mL 的参与者相比。在没有心血管疾病史但 NT-proBNP 较高的人群中，心血管风险升高与心血管疾病史相关的风险相似或更高。
我们的研究结果表明，对于 NT-proBNP≥450 pg/mL 的成年人，将其视为有临床心血管疾病史可能是合适的。
