The potential to improve primary prevention in the future by using BNP/N-BNP as an indicator of silent 'pancardiac' target organ damage: BNP/N-BNP could become for the heart what microalbuminuria is for the kidney.
Brain natriuretic peptide (BNP) or N-terminal pro-BNP (N-BNP) now appears to be the best independent predictor of cardiovascular mortality over and above the conventional ones like blood pressure. This may be because a high BNP/N-BNP is identifying any form of asymptomatic cardiac target organ damage (TOD) [especially silent ischaemia, left ventricular hypertrophy (LVH), left atrial dilatation/atrial fibrillation (LAD/AF) and LV systolic dysfunction (LVSD)]. There are strong hints that BNP/N-BNP will also identify those who are going to develop LVH, LAD/AF, and LVSD in a few years' time. Thus, the prospects are good that BNP/N-BNP could be used to identify 'pancardiac' TOD, even when it is silent and that this information could be 'harnessed' to improve primary prevention. BNP/N-BNP could become to the heart what microalbuminuria is to the kidneys, i.e. an indicator of early, silent TOD.
Struthers
Allan
A
Division of Medicine and Therapeutics, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK. a.d.struthers@dundee.ac.uk
Lang
Chim
C
D015415:Biomarkers / Q000097:blood; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D006333:Heart Failure / Q000209:etiology* / Q000401:mortality; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011322:Primary Prevention / Q000379:methods; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain