N-terminal pro-brain natriuretic peptide and cardiovascular or all-cause mortality in the general population: A meta-analysis

Abstract

The prognostic role of N-terminal pro-brain natriuretic peptide (NT-proBNP) in the general population remains controversial. We conducted this meta-analysis to investigate the association between baseline NT-proBNP concentrations and cardiovascular or all-cause mortality in the general population. PubMed and Embase databases were systematically searched from their inception to August 2016. Prospective observational studies that investigated the association between baseline NT-proBNP concentrations and cardiovascular or all-cause mortality in the general population were eligible. A summary of the hazard ratio (HR) and 95% confidence interval (CI) of mortality were calculated by the highest versus the lowest category of NT-proBNP concentrations. Eleven studies with a total of 25,715 individuals were included. Compared individuals in the highest with those in the lowest category of NT-proBNP, the pooled HR was 2.44 (95% CI 2.11-2.83) for all-cause mortality, 3.77 (95% CI 2.85-5.00) for cardiovascular mortality, and 2.35 (95% CI 1.45-3.82) for coronary heart disease mortality, respectively. Subgroup analyses indicated that the effects of NT-proBNP on the risk of cardiovascular mortality (RR 2.27) and all-cause mortality (RR 3.00) appeared to be slightly lower among men. Elevated NT-proBNP concentrations appeared to be independently associated with increased risk of cardiovascular and all-cause mortality in the general population.

Figure 1. Flow chart of the study selection process.

Figure 2. Forest plots showing pooled hazard ratio and 95% confidence interval of all-cause mortality comparing the highest with the lowest concentrations of N-terminal pro-brain natriuretic peptide in a fixed-effect model.

Figure 3. Forest plots showing pooled hazard ratio and 95% confidence interval of cardiovascular mortality comparing the highest with the lowest concentrations of N-terminal pro-brain natriuretic peptide in a random effect model.

Figure 4. Forest plots showing pooled hazard ratio and 95% confidence interval of coronary heart disease mortality comparing the highest with the lowest concentrations of N-terminal pro-brain natriuretic peptide in a fixed-effect model.