N-Terminal Pro-Brain Natriuretic Peptide and Risk of Cardiovascular Events in a Japanese Community
The Hisayama Study
Objective—Few studies have examined the association between natriuretic peptides and the incidence of cardiovascular disease (CVD) in Asian populations.
Methods and Results—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.
Conclusion—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.
- Received January 18, 2011.
- Accepted August 25, 2011.
- © 2011 American Heart Association, Inc.