title: Prediction of heart failure by amino terminal-pro-B-type natriuretic peptide and C-reactive protein in subjects with cerebrovascular disease.
abstract: B-type natriuretic peptide (BNP) and C-reactive protein (CRP) are elevated in persons at risk for congestive heart failure (CHF). However, limited data are available directly comparing BNP-related peptides and CRP in persons at risk of CHF. To evaluate amino terminal-pro-BNP (NT-proBNP) and CRP, separately and together, for assessment of risk of CHF, we performed a nested case-control study of the 6105 participants of the Perindopril pROtection aGainst REcurrent Stroke Study (PROGRESS), a placebo-controlled study of a perindopril-based blood pressure-lowering regimen among individuals with previous stroke or transient ischemic attack (TIA). Each of 258 subjects who developed CHF resulting in death, hospitalization, or withdrawal of randomized therapy during a mean follow-up of 3.9 years was matched to 1 to 3 control subjects. NT-proBNP and CRP predicted CHF; the odds ratio for subjects in the highest compared with the lowest quarter was 4.5 (95% confidence interval, 2.7 to 7.5) for NT-proBNP and 2.9 (confidence interval, 1.9 to 4.7) for CRP, and each remained a predictor of CHF after adjustment for all other predictors. Screening for both markers provided better prognostic information than screening for either alone. Elevation of NT-proBNP above 50 pmol/L and CRP above 0.84 mg/L predicted CHF with sensitivity of 64% and specificity of 66%. NT-proBNP and CRP predicted CHF in subjects receiving perindopril-based therapy. We conclude that NT-proBNP and CRP are independent predictors of CHF risk after stroke or TIA. Moreover, NT-proBNP and CRP may be markers of mechanisms of CHF pathogenesis distinct from those responsive to angiotensin-converting enzyme inhibitor-based therapy.
authors.affiliation: St. Vincent's Institute of Medical Research, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia. dcampbell@svi.edu.au
authors.forename: Duncan J
authors.initials: DJ
authors.lastname: Campbell
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.forename: John P
authors.initials: JP
authors.lastname: Chalmers
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Colman
authors.forename: Alicia J
authors.initials: AJ
authors.lastname: Jenkins
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Kemp
authors.forename: Bruce C
authors.initials: BC
authors.lastname: Neal
authors.forename: Anushka
authors.initials: A
authors.lastname: Patel
authors.forename: Stephen W
authors.initials: SW
authors.lastname: MacMahon
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis*; D016022:Case-Control Studies; D002561:Cerebrovascular Disorders / Q000097:blood* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000453:epidemiology*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000097:blood / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain; D009419:Nerve Tissue Proteins / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D020913:Perindopril / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020521:Stroke / Q000097:blood / Q000453:epidemiology
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D015415:Biomarkers; D009419:Nerve Tissue Proteins; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein; D020913:Perindopril