title: Long-term pattern of brain natriuretic peptide and N-terminal pro brain natriuretic peptide and its determinants in the general population: contribution of age, gender, and cardiac and extra-cardiac factors.
abstract: OBJECTIVE
  The natriuretic peptides BNP and NT-proBNP are potent cardiac markers, but knowledge of long-term changes is sparse. We thus quantified determinants of change in BNP and NT-proBNP in a study of south German residents (KORA).
  
  
  RESULTS
  A total of 1005 men and women (age 25-74 years, mean 48 years) underwent physical examination and echocardiography at baseline and at follow-up after 10 years. The current analysis comprised 877 subjects with dual measurements of BNP and NT-proBNP. Both markers increased in both sexes (P < 0.001) during the 10-year follow-up, and higher levels in women persisted across time (P for sex difference <0.001). Among baseline covariates, predictors for 10-year change of NT-proBNP, BNP, or both were age, sex, diabetes status, and heart rate (multivariable regression analysis, each P < 0.05). However, changes of covariates over the 10-year follow-up were much stronger determinants. Specifically, incident myocardial infarction, new beta-blocker medication, and increased cardiac parameters (left atrial diameter, LV end-diastolic diameter, and LV mass index) were associated with increasing BNP, NT-proBNP, or both, whereas increased heart rate, haematocrit, and body mass index (BMI) were associated with decreasing BNP and NT-proBNP (all P < 0.05).
  
  
  CONCLUSIONS
  Next to ageing and sex, a variety of changes in covariates reflecting the sequelae of cardiac remodelling as well as myocardial infarction and diabetes influence long-term changes of BNP and NT-proBNP. Of note, diabetes and increased BMI exert opposite effects. For interpretation of individual marker concentrations, a host of covariates needs to be considered, especially in subjects without prevalent or incident cardiac disease.
authors.affiliation: Klinik und Poliklinik für Innere Medizin II, Klinikum der Universität Regensburg, Regensburg, Germany. andreas.luchner@ukr.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Luchner
authors.forename: Gundula
authors.initials: G
authors.lastname: Behrens
authors.forename: Jan
authors.initials: J
authors.lastname: Stritzke
authors.forename: Marcello
authors.initials: M
authors.lastname: Markus
authors.forename: Klaus
authors.initials: K
authors.lastname: Stark
authors.forename: Annette
authors.initials: A
authors.lastname: Peters
authors.forename: Christa
authors.initials: C
authors.lastname: Meisinger
authors.forename: Michael
authors.initials: M
authors.lastname: Leitzmann
authors.forename: Hans-Werner
authors.initials: HW
authors.lastname: Hense
authors.forename: Heribert
authors.initials: H
authors.lastname: Schunkert
authors.forename: Iris M
authors.initials: IM
authors.lastname: Heid
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000375:Aging / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology; D004452:Echocardiography; D005260:Female; D005858:Germany / Q000453:epidemiology; D006325:Heart Atria / Q000000981:diagnostic imaging; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood* / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000453:epidemiology; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009929:Organ Size; D010446:Peptide Fragments / Q000097:blood*; D012044:Regression Analysis; D012737:Sex Factors
chemical_list: D000319:Adrenergic beta-Antagonists; D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: 10-year-follow-up; Echocardiography; Heart failure; Hypertension; LV hypertrophy; Natriuretic peptides