Article thumbnail

Natriuretic Peptides and Assessment of Cardiovascular Disease Risk in Asymptomatic Persons

By Lori B. Daniels

Abstract

Current tools for cardiovascular disease (CVD) risk assessment in asymptomatic individuals are imperfect. Preventive measures aimed only at individuals deemed high risk by current algorithms neglect large numbers of low-risk and intermediate-risk individuals who are destined to develop CVD and who would benefit from early and aggressive treatment. Natriuretic peptides have the potential both to identify individuals at risk for future cardiovascular events and to help detect subclinical CVD. Choosing the appropriate subpopulation to target for natriuretic peptide testing will help maximize the performance and the cost effectiveness. The combined use of multiple risk markers, including biomarkers, genetic testing, and imaging or other noninvasive measures of risk, offers promise for further refining risk assessment algorithms. Recent studies have highlighted the utility of natriuretic peptides for preoperative risk stratification; however, cost effectiveness and outcomes studies are needed to affirm this and other uses of natriuretic peptides for cardiovascular risk assessment in asymptomatic individuals

Topics: Article
Publisher: Current Science Inc.
OAI identifier: oai:pubmedcentral.nih.gov:2894089
Provided by: PubMed Central

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.

Suggested articles

Citations

  1. (2009). A preliminary report on the prognostic significance of preoperative brain natriuretic peptide and postoperative cardiac troponin in patients undergoing major vascular surgery. Anesth Analg
  2. (2006). A: B-type natriuretic peptide: time to incorporate natriuretic peptides in our practice.
  3. (2002). AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke:
  4. (2006). Amino-terminal pro-B-type natriuretic peptide and B-type natri126 Curr Cardio Risk Rep (2010) 4:120–127uretic peptide in the general community: determinants and detection of left ventricular dysfunction.
  5. (2006). Amino-terminal pro-B-type natriuretic peptide and B-type natriuretic peptide: biomarkers for mortality in a large community-based cohort free of heart failure. Hypertension
  6. (2006). Assessment of cardiac risk before noncardiac surgery: brain natriuretic peptide in 1590 patients. Heart
  7. (1998). Biochemical detection of left-ventricular systolic dysfunction. Lancet
  8. (2008). BM: A meta-analysis of the utility of pre-operative brain natriuretic peptide in predicting early and intermediate-term mortality and major adverse cardiac events in vascular surgical patients. Anaesthesia
  9. (2004). Costeffectiveness of screening with B-type natriuretic peptide to identify patients with reduced left ventricular ejection fraction.
  10. (2004). Diagnostic and prognostic evaluation of left ventricular systolic heart failure by plasma N-terminal pro-brain natriuretic peptide concentrations in a large sample of the general population. Heart
  11. (2010). Education Prgram (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III):
  12. (1992). Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions.
  13. (1991). Enhancing and evaluating diagnostic accuracy. Med Decis Making
  14. et al.: Prognosis of stage A or B heart failure patients with elevated B-type natriuretic peptide levels.
  15. (2000). Evaluation of brain natriuretic peptide as marker of left ventricular dysfunction and hypertrophy in the population.
  16. (2007). Evidence-based guidelines for cardiovascular disease prevention in women:
  17. (2006). Feasibility of treating prehypertension with an angiotensin-receptor blocker.
  18. (2001). Head-to-head comparison of N-terminal pro-brain natriuretic peptide, brain natriuretic peptide and N-terminal pro-atrial natriuretic peptide in diagnosing left ventricular dysfunction. Clin Chim Acta
  19. (2004). Head-to-head comparison of the diagnostic utility of BNP and NT-proBNP in symptomatic and asymptomatic structural heart disease. Clin Chim Acta
  20. (2003). HJ: Retrospective analysis of the cost-effectiveness of using plasma brain natriuretic peptide in screening for left ventricular systolic dysfunction in the general population.
  21. (2002). Introducing a new role for BNP: as a general indicator of cardiac structural disease rather than a specific indicator of systolic dysfunction only. Heart
  22. (2006). Limitations of current cardiovascular disease risk assessment strategies in women. J Womens Health (Larchmt)
  23. (2007). Maisel AS: Natriuretic peptides.
  24. (2003). Major risk factors as antecedents of fatal and nonfatal coronary heart disease events. JAMA
  25. (1995). Meta-analysis of Pap test accuracy.
  26. (2008). Minimally elevated cardiac troponin T and elevated N-terminal pro-B-type natriuretic peptide predict mortality in older adults: results from the Rancho Bernardo Study.
  27. (2009). Multiple biomarker assessment in primary prevention of cardiovascular disease. Curr Cardiov Risk Rep
  28. (2006). Multiple biomarkers for the prediction of first major cardiovascular events and death.
  29. (2008). MW: The comparability of models for predicting the risk of a positive prostate biopsy with prostate-specific antigen alone: a systematic review. Eur Urol
  30. (2006). N-terminal brain natriuretic peptide predicted cardiovascular events stronger than high-sensitivity C-reactive protein in hypertension: a LIFE substudy. J Hypertens
  31. (2005). N-terminal pro-brain natriuretic peptide, C-reactive protein, and urinary albumin levels as predictors of mortality and cardiovascular events in older adults. JAMA
  32. (2007). N-terminal probrain natriuretic peptide, but not high sensitivity C-reactive protein, improves cardiovascular risk prediction in the general population. Eur Heart J
  33. (2008). N-terminal prohormone brain natriuretic peptide as a predictor of cardiovascular disease and mortality in blacks with hypertensive kidney disease: the African American Study of Kidney Disease and Hypertension (AASK). Circulation
  34. (2009). Novel and conventional biomarkers for prediction of incident cardiovascular events in the community. JAMA
  35. Papers of particular interest, published recently, have been highlighted as:
  36. (2008). Plasma brain natriuretic peptide concentrations and the risk of cardiovascular events and death in general practice.
  37. (2004). Plasma brain natriuretic peptide to detect preclinical ventricular systolic or diastolic dysfunction: a community-based study. Circulation
  38. (2006). Plasma N-terminal fragments of natriuretic propeptides predict the risk of cardiovascular events and mortality in middle-aged men. Eur Heart J
  39. (2005). Plasma N-terminal pro-brain natriuretic peptide concentration predicts coronary events in men at work: a report from the BELSTRESS study. Eur Heart J
  40. (2004). Plasma natriuretic peptide levels and the risk of cardiovascular events and death.
  41. (2002). Plasma natriuretic peptides for community screening for left ventricular hypertrophy and systolic dysfunction: the Framingham heart study. JAMA
  42. (2009). Pre-operative cardiac risk assessment in noncardiac surgery: are natriuretic peptides the magic bullet?
  43. (2009). Preclinical systolic and diastolic dysfunction assessed by tissue doppler imaging is associated with elevated plasma pro-B-type natriuretic peptide concentrations.
  44. (1998). Prediction of coronary heart disease using risk factor categories. Circulation
  45. (2003). Prevalence of conventional risk factors in patients with coronary heart disease. JAMA
  46. (2009). Prognostic accuracy of Bnatriuretic peptide measurements and coronary artery calcium in asymptomatic subjects (from the Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research [EISNER] study).
  47. (2009). Prognostic value of brain natriuretic peptide in noncardiac surgery: a metaanalysis. Anesthesiology
  48. (2003). Prognostic value of high plasma brain natriuretic peptide concentrations in very elderly persons.
  49. (2005). Relative importance of borderline and elevated levels of coronary heart disease risk factors. Ann Intern Med 2005, 142:393–402. (Published erratum appears in Ann Intern Med
  50. (2004). Reliability of N-terminal proBNP assay in diagnosis of left ventricular systolic dysfunction within representative and high risk populations. Heart
  51. (1985). Sick individuals and sick populations.
  52. (1968). The evaluation of the worth of early disease detection.
  53. (2006). The limitations of risk factors as prognostic tools.
  54. (2001). The real contribution of the major risk factors to the coronary epidemics: time to end the “only-50%” myth. Arch Intern Med
  55. (2009). The role of N-terminal PRO-brain natriuretic peptide and echocardiography for screening asymptomatic left ventricular dysfunction in a population at high risk for heart failure. The PROBE-HF study.
  56. (2005). Treatment with drugs to lower blood pressure and blood cholesterol based on an individual’s absolute cardiovascular risk. Lancet
  57. (2007). Use and misuse of the receiver operating characteristic curve in risk prediction. Circulation
  58. (2008). Use of multiple biomarkers to improve the prediction of death from cardiovascular causes.
  59. (2005). Usefulness of serial measurement of N-terminal pro-brain natriuretic peptide plasma levels in asymptomatic patients with aortic stenosis to predict symptomatic deterioration.
  60. (2002). Value of plasma B type natriuretic peptide measurement for heart disease screening in a Japanese population. Heart
  61. (2008). Vasan RS: Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med
  62. (2003). Vasan RS: The epidemiology of “asymptomatic” left ventricular systolic dysfunction: implications for screening. Ann Intern Med
  63. (2005). What is the normal range for N-terminal pro-brain natriuretic peptide? How well does this normal range screen for cardiovascular disease? Eur Heart J