title: Atrial natriuretic peptide and the development of congestive heart failure in the oldest old: a seven-year prospective study.
abstract: BACKGROUND
  Atrial natriuretic peptide (ANP) levels are elevated in symptomatic heart failure and correlate with invasively measured left heart pressures.
  
  
  OBJECTIVE
  To examine the association between plasma ANP level and the subsequent development of congestive heart failure (CHF) in older subjects with no history of CHF.
  
  
  METHODS
  A 7-year, prospective, blinded, cohort study.
  
  
  METHODS
  A life care facility in Boston, Massachusetts.
  
  
  METHODS
  Two hundred fifty-six frail older subjects (mean age 88 +/- 7) with no history of CHF at study entry.
  
  
  METHODS
  Clinical episodes of CHF with confirmatory chest roentgenogram findings. Cox proportional hazard analyses were performed to examine the relationship between ANP levels and the development of CHF while controlling for 19 clinical, physical, and laboratory parameters. A Kaplan-Meier estimator (log-rank test) was used to determine if the development of CHF differed by tertile of ANP.
  
  
  RESULTS
  During the follow-up period, 32% of the cohort developed CHF. The mean ANP level in the CHF group was 95 pmol/L +/- 11 pmol/L versus 60 pmol/L +/- 5 pmol/L in the no CHF group (two tailed t test P = .005). On multivariate analysis, a high ANP level was found to be associated significantly (P = .01) with the development of CHF.
  
  
  CONCLUSIONS
  There is a statistically significant association between ANP level and the subsequent development of CHF in frail older individuals with no history of CHF.
authors: Harvard Medical School Division on Aging, and Massachusetts General Hospital, Boston, USA.
authors: E L
authors: EL
authors: Knight
authors: L C
authors: LC
authors: Fish
authors: D K
authors: DK
authors: Kiely
authors: E R
authors: ER
authors: Marcantonio
authors: K M
authors: KM
authors: Davis
authors: K L
authors: KL
authors: Minaker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over / Q000706:statistics & numerical data*; D000704:Analysis of Variance; D009320:Atrial Natriuretic Factor / Q000097:blood*; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000209:etiology*; D006801:Humans; D015993:Life Tables; D008297:Male; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D016037:Single-Blind Method; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D009320:Atrial Natriuretic Factor