title: NT-proBNP is superior to BNP for predicting first cardiovascular events in the general population: the Heinz Nixdorf Recall Study.
abstract: BACKGROUND
  B-type natriuretic peptide (BNP) as well as N-terminal-proBNP (NT-proBNP) are associated with cardiac events in the general population. Yet, data from the general population comparing both peptides for their prognostic value is lacking.
  
  
  METHODS
  Participants from the population-based Heinz-Nixdorf-Recall-study without cardiovascular diseases were included. Associations of BNP and NT-proBNP with incident cardiovascular events (incident myocardial infarction, stroke, or cardiovascular death) were assessed using Cox regression; prognostic value was addressed using Harrell's c statistic.
  
  
  RESULTS
  From overall 3589 subjects (mean age: 59.3 ± 7.7 yrs, 52.5% female), 235 subjects developed a cardiovascular event during 8.9 ± 2.2 yrs of follow-up. In regression analysis both natriuretic peptides were associated with incident cardiovascular events, independent of traditional risk factors (hazard ratio (HR) per unit increase on log-scale (95% CI): NT-proBNP: 1.60 (1.39; 1.84); BNP: 1.37 (1.19; 1.58), p<0.0001 respectively). Specifically looking at subjects <60 yrs only NT-proBNP, was linked with events (HR (95% CI): 1.59 (1.19; 2.13) for NT-proBNP, p=0.0019; HR: 1.25 (0.94; 1.65) for BNP, p=0.12, after adjustment for age and gender). Similar results were observed for females (HR (95% CI) 1.65 (1.28; 2.12), p=0.0001 for NT-proBNP, and 1.24 (0.96; 1.61), p=0.10 for BNP after adjustment for age). Adding NT-proBNP/BNP to traditional risk factors increased the prognostic value, with effects being stronger for NT-proBNP (Harrell's c, 0.724 to 0.741, p=0.034) as compared to BNP (0.724 to 0.732, p=0.20).
  
  
  CONCLUSIONS
  Both, NT-proBNP and BNP are associated with future cardiovascular events in the general population. However, when both are available, NT-proBNP seems to be superior due to its higher prognostic value, especially in younger subjects and females.
authors: The Cardiovascular Center, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany; The West-German Heart Center, Department of Cardiology, University of Duisburg-Essen, Essen, Germany. Electronic address: k.kara@klinikum-bochum.de.
authors: Kaffer
authors: K
authors: Kara
authors: The Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany.
authors: Nils
authors: N
authors: Lehmann
authors: The West-German Heart Center, Department of Cardiology, University of Duisburg-Essen, Essen, Germany.
authors: Till
authors: T
authors: Neumann
authors: The West-German Heart Center, Department of Cardiology, University of Duisburg-Essen, Essen, Germany.
authors: Hagen
authors: H
authors: Kälsch
authors: Krankenhaus Bethanien, Department of Cardiology, Moers, Germany.
authors: Stefan
authors: S
authors: Möhlenkamp
authors: The West-German Heart Center, Department of Cardiology, University of Duisburg-Essen, Essen, Germany.
authors: Iryna
authors: I
authors: Dykun
authors: Institute of Clinical Chemistry and Laboratory Medicine, University of Duisburg-Essen, Essen, Germany.
authors: Martina
authors: M
authors: Broecker-Preuss
authors: The Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany.
authors: Noreen
authors: N
authors: Pundt
authors: The Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany.
authors: Susanne
authors: S
authors: Moebus
authors: The Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany.
authors: Karl-Heinz
authors: KH
authors: Jöckel
authors: The West-German Heart Center, Department of Cardiology, University of Duisburg-Essen, Essen, Germany.
authors: Raimund
authors: R
authors: Erbel
authors: The West-German Heart Center, Department of Cardiology, University of Duisburg-Essen, Essen, Germany.
authors: Amir A
authors: AA
authors: Mahabadi
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism*; D015331:Cohort Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D010446:Peptide Fragments / Q000378:metabolism*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: BN; Epidemiology; General population; Heinz Nixdorf Recall Study; Natriuretic peptides; PNT-proBNP; Risk prediction