title: B-type natriuretic peptide and the risk of cardiovascular events and death in patients with stable angina: results from the AtheroGene study.
abstract: OBJECTIVE
  The aim of this study was to assess the predictive value of the cardiac hormone B-type natriuretic peptide (BNP) for long-term outcome in a large cohort of stable angina patients.
  
  
  BACKGROUND
  Recent data suggest a role of BNP in stable ischemic heart disease beyond its known value in heart failure and acute coronary syndromes.
  
  
  METHODS
  In 1,085 patients with coronary artery disease (CAD) baseline levels of BNP were prospectively associated with cardiovascular (CV) events during a mean follow-up of 2.5 years.
  
  
  RESULTS
  BNP concentrations were significantly elevated in patients with future CV events (median [25th/75th interquartile range] 119.2 [43.6/300.4] pg/ml vs. 36.2 [11.3/94.6] pg/ml; p < 0.001). Kaplan-Meier survival analysis showed a stepwise decrease in event-free survival across quartiles of BNP baseline concentration (p(log rank) < 0.001). Patients in the highest quartile revealed a 6.1-fold increased risk (p = 0.001) compared to patients in the lowest quartile after adjustment for potential confounders. For a cut-off value of 100 pg/ml, an independently increased risk of adverse outcome (hazard ratio [HR] 4.4; p < 0.001) could be demonstrated. One standard deviation (SD) decrease in ejection fraction implied the most prominent increase in risk of future CV events (HR 1.69; p < 0.001) followed by one SD increase in BNP (HR 1.53; p < 0.001). The highest prognostic accuracy could be demonstrated for BNP (area under the curve 0.671).
  
  
  CONCLUSIONS
  The data of this large group of CAD patients provide independent evidence that BNP is a strong predictor of cardiovascular risk in patients with stable angina independent of left ventricular systolic performance and known risk factors.
authors.affiliation: Department of Medicine II, Johannes Gutenberg University, Mainz, Germany. schnabelr@gmx.de
authors.forename: Renate
authors.initials: R
authors.lastname: Schnabel
authors.forename: Edith
authors.initials: E
authors.lastname: Lubos
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Rupprecht
authors.forename: Christine
authors.initials: C
authors.lastname: Espinola-Klein
authors.forename: Christoph
authors.initials: C
authors.lastname: Bickel
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Lackner
authors.forename: François
authors.initials: F
authors.lastname: Cambien
authors.forename: Laurence
authors.initials: L
authors.lastname: Tiret
authors.forename: Thomas
authors.initials: T
authors.lastname: Münzel
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
mesh_terms: D000787:Angina Pectoris / Q000097:blood* / Q000150:complications; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain