title: Plasma B-type natriuretic peptide as a predictor of cardiovascular events in subjects with atrial fibrillation: a community-based study.
abstract: OBJECTIVE
  Atrial fibrillation (AF) is a significant public health issue due to its high prevalence in the general population, and is associated with an increased risk of cardiovascular (CV) events including systemic thrombo-embolism, heart failure, and coronary artery disease. The relationship between plasma B-type natriuretic peptide (BNP) and CV risk in real world AF subjects remains unknown.
  
  
  METHODS
  The subject of the study (n = 228; mean age = 69 years) was unselected individuals with AF in a community-based population (n = 15,394; AF prevalence rate = 1.5%). The CV event free rate within each BNP tertile was estimated, and Cox regression analysis was performed to examine the relative risk of the onset of CV events among the tertiles. The prognostic ability of BNP was compared to an established risk score for embolic events (CHADS2 score). In addition, to determine the usefulness of BNP as a predictor in addition to CHADS2 score, we calculated Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI) indices.
  
  
  RESULTS
  During the follow-up period 58 subjects experienced CV events (52 per 1,000 person-years). The event-free ratio was significantly lower in the highest tertile (p < 0.02). After adjustment for established CV risk factors, the hazard ratio (HR) of the highest tertile was significantly higher than that of the lowest tertile (HR = 2.38; p < 0.02). The predictive abilities of plasma BNP in terms of sensitivity and specificity for general CV events were comparable to those of CHADS2 score. Adding BNP to the CHADS2 score only model improved the NRI (0.319; p < 0.05) and the IDI (0.046; p < 0.05).
  
  
  CONCLUSIONS
  Plasma BNP is a valuable biomarker both singly or in combination with an established scoring system for assessing general CV risk including stroke, heart failure and acute coronary syndrome in real-world AF subjects.
authors: Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
authors: Motoyuki
authors: M
authors: Nakamura
authors: Yorihiko
authors: Y
authors: Koeda
authors: Fumitaka
authors: F
authors: Tanaka
authors: Toshiyuki
authors: T
authors: Onoda
authors: Kazuyoshi
authors: K
authors: Itai
authors: Masaki
authors: M
authors: Ohsawa
authors: Kozo
authors: K
authors: Tanno
authors: Kiyomi
authors: K
authors: Sakata
authors: Shinich
authors: S
authors: Omama
authors: Yasuhiro
authors: Y
authors: Ishibashi
authors: Shinji
authors: S
authors: Makita
authors: Mutsuko
authors: M
authors: Ohta
authors: Kuniaki
authors: K
authors: Ogasawara
authors: Takashi
authors: T
authors: Komatsu
authors: Akira
authors: A
authors: Okayama
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood* / Q000150:complications*; D002318:Cardiovascular Diseases / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012306:Risk
chemical_list: D020097:Natriuretic Peptide, Brain