title: Predictive utility of atrial, N-terminal pro-atrial, and N-terminal pro-B-type natriuretic peptides for mortality and cardiovascular events in the general community: a 9-year follow-up study.
abstract: OBJECTIVE
  To determine the predictive value of atrial natriuretic peptide (ANP), N-terminal pro-ANP (NT-proANP), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) for mortality and cardiovascular events in the general population in the absence of overt heart failure (HF).
  
  
  METHODS
  We identified a community-based cohort of 2042 individuals. Those with stage C or D HF (n=45) and renal insufficiency (n=6) were excluded from the current study. Of the remaining individuals, 1769 (89%) underwent echocardiography and measurement of plasma ANP, NT-proANP, and NT-proBNP. Participants were followed up from January 1, 1997, to May 1, 2009, for mortality, HF, myocardial infarction (MI), and cerebrovascular accident; median follow-up was 9 years.
  
  
  RESULTS
  After adjustment for conventional clinical risk factors, NT-proANP had significant predictive value for mortality but not for HF, MI, or cerebrovascular accident, whereas ANP lacked any predictive value. The predictive value of NT-proANP for mortality was attenuated after adjustment for structural and functional cardiac abnormalities. In contrast, NT-proBNP had predictive value for mortality, HF, and MI after adjustment for conventional risk factors and retained significance for mortality and HF after adjustment for structural and functional cardiac abnormalities.
  
  
  CONCLUSIONS
  Our results suggest that NT-proBNP is a more robust cardiac biomarker compared with ANP or NT-proANP and is independently predictive of mortality and HF in the general population free of overt HF.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA. mckie.paul@mayo.edu
authors.forename: Paul M
authors.initials: PM
authors.lastname: McKie
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cataliotti
authors.forename: S Jeson
authors.initials: SJ
authors.lastname: Sangaralingham
authors.forename: Tomoko
authors.initials: T
authors.lastname: Ichiki
authors.forename: Valentina
authors.initials: V
authors.lastname: Cannone
authors.forename: Kent R
authors.initials: KR
authors.lastname: Bailey
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Redfield
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Rodeheffer
authors.forename: John C
authors.initials: JC
authors.lastname: Burnett
mesh_terms: D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D011863:Radioimmunoassay; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors
chemical_list: D015415:Biomarkers; C099254:N-terminal proatrial natriuretic peptide; D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor