The prognostic value of the plasma N-terminal pro-brain natriuretic peptide level on all-cause death and major cardiovascular events in a community-based population

Abstract

Background: Despite growing evidence that N-terminal pro-brain natriuretic peptide (NT-proBNP) has an important prognostic value for patients with cardiovascular disease, chronic kidney disease, etc, the prognostic significance of NT-proBNP levels in the general population has not been established. The aim of this study was to evaluate the clinical significance of NT-proBNP in a community population.

Methods: This is a community-based prospective survey of residents from two communities in Beijing conducted for a routine health status checkup. Out of 1,860 individuals who were eligible for inclusion from 2007 to 2009, 1,499 completed a follow-up and were assessed for the prognostic value of NT-proBNP in 2013. A questionnaire was used for end point events. Anthropometry and blood pressure were measured. Plasma NT-proBNP, creatinine, lipids, and glucose were determined.

Results: A total of 1,499 subjects with complete data were included in the analysis. Participants were divided into four groups according to baseline NT-proBNP levels (quartile 1, <19.8 pg/mL; quartile 2, 19.8-41.6 pg/mL; quartile 3, 41.7-81.8 pg/mL; quartile 4, ≥81.9 pg/mL). During a median 4.8-year follow-up period, the all-cause mortality rate rose from 0.8% in the lowest concentration NT-proBNP group (<19.8 pg/mL) to 7.8% in the highest NT-proBNP group (≥81.9 pg/mL; P<0.001). The incidence of major adverse cardiovascular events (MACEs) increased from 3.1% in the lowest NT-proBNP group to 18.9% in the highest group (P<0.001). Individuals in the highest NT-proBNP group (≥81.9 pg/mL) were associated with higher risk of all-cause death and MACEs compared with the lowest NT-proBNP group using Kaplan-Meier survival curves and the Cox proportional hazard model after adjusting for age, sex, and traditional risk factors.

Conclusion: The plasma NT-proBNP level is a strong and independent prognosis factor for all-cause death and MACEs in the community population. The NT-proBNP cut-point for the prognostic value remains to be further studied. NT-proBNP is a strong and independent prognostic factor for all-cause death and MACEs in individuals older than 65 years and MACEs in individuals younger than 65 years.

Keywords: NT-proBNP; community population; prognosis.

Figure 1

The Kaplan–Meier curves demonstrating incidence of all-cause mortality in community residents with different NT-proBNP levels (quartile 1: <19.8 pg/mL, quartile 2: 19.8–41.6 pg/mL, quartile 3: 41.7–81.8 pg/mL, quartile 4: ≥81.9 pg/mL). Note: The all-cause mortality risk in the quartile 4 (7.8%) was significantly higher than that in the quartile 1 (0.8%) (HR, 3.59; P<0.001; 95% CI, 1.22–8.81). Abbreviations: NT-proBNP, N-terminal pro-brain natriuretic peptide; HR, hazard ratio; CI, confidence interval.

Figure 2

Kaplan–Meier cumulative incidence of MACEs in the four groups of individuals was divided according to the level of the NT-proBNP. Note: The incidence of MACEs in the quartile 4 (18.9%) was significantly higher than in the quartile 1 (3.1%) (HR, 6.52; P<0.001; 95% CI, 3.53–12.03). Abbreviations: MACEs, major adverse cardiovascular events; NT-proBNP, N-terminal pro-brain natriuretic peptide; HR, hazard ratio; CI, confidence interval.

Figure 3

An ROC curve of NT-proBNP to predict the all cause death. Note: The AUC was 0.74 (95% CI, 0.66–0.83). Abbreviations: ROC, receiver operating characteristic; NT-proBNP, N-terminal pro-brain natriuretic peptide; AUC, area under curves; CI, confidence interval.

Figure 4

An ROC curve of NT-proBNP to predict MACEs. Note: The AUC was 0.64 (95% CI, 0.57–0.70). Abbreviations: ROC, receiver operating characteristic; NT-proBNP, N-terminal pro-brain natriuretic peptide; MACEs, major adverse cardiovascular event; AUC, area under curves; CI, confidence interval.