title: B-type natriuretic peptides and cardiovascular risk: systematic review and meta-analysis of 40 prospective studies.
abstract: BACKGROUND
  Measurement of B-type natriuretic peptide (BNP) concentration or its precursor (N-terminal fragment [NT-proBNP]) is recommended in patients with symptoms of left ventricular dysfunction and in other settings, but the relevance of these peptides to cardiovascular disease (CVD) in general populations or in patients with stable vascular disease is uncertain.
  
  
  RESULTS
  Data were collated from 40 long-term prospective studies involving a total of 87 474 participants and 10 625 incident CVD outcomes. In a comparison of individuals in the top third with those in the bottom third of baseline values of natriuretic peptides, the combined risk ratio (RR), adjusted for several conventional risk factors, was 2.82 (95% confidence interval [CI], 2.40 to 3.33) for CVD. Analysis of the 6 studies with at least 250 CVD outcomes (which should be less prone to selective reporting than are smaller studies) yielded an adjusted RR of 1.94 (95% CI, 1.57 to 2.39). RRs were broadly similar with BNP or NT-proBNP (RR, 2.89 [95% CI, 1.91 to 4.38] and 2.82 [95% CI, 2.35 to 3.38], respectively) and by different baseline vascular risk (RR, 2.68 [95% CI, 2.07 to 3.47] in approximately general populations; RR, 3.35 [95% CI, 2.38 to 4.72] in people with elevated vascular risk factors; RR, 2.60 [95% CI, 1.99 to 3.38] in patients with stable CVD). Assay of BNP or NT-proBNP in addition to measurement of conventional CVD risk factors yielded generally modest improvements in risk discrimination.
  
  
  CONCLUSIONS
  Available prospective studies indicate strong associations between circulating concentration of natriuretic peptides and CVD risk under a range of different circumstances. Further investigation is warranted, particularly in large general population studies, to clarify any predictive utility of these markers and to better control for publication bias.
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Wort's Causeway, Cambridge, England CB1 8RN. emanuele.diangelantonio@phpc.cam.ac.uk
authors.forename: Emanuele
authors.initials: E
authors.lastname: Di Angelantonio
authors.forename: Rajiv
authors.initials: R
authors.lastname: Chowdhury
authors.forename: Nadeem
authors.initials: N
authors.lastname: Sarwar
authors.forename: Kausik K
authors.initials: KK
authors.lastname: Ray
authors.forename: Reeta
authors.initials: R
authors.lastname: Gobin
authors.forename: Danish
authors.initials: D
authors.lastname: Saleheen
authors.forename: Alexander
authors.initials: A
authors.lastname: Thompson
authors.forename: Vilmundur
authors.initials: V
authors.lastname: Gudnason
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
authors.forename: John
authors.initials: J
authors.lastname: Danesh
mesh_terms: D002318:Cardiovascular Diseases / Q000097:blood* / Q000453:epidemiology*; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D012307:Risk Factors
chemical_list: D020097:Natriuretic Peptide, Brain