title: N-Terminal Pro-Brain Natriuretic Peptide Is Associated with a Future Diagnosis of Cancer in Patients with Coronary Artery Disease.
abstract: OBJECTIVE
  Several papers have reported elevated plasma levels of natriuretic peptides in patients with a previous diagnosis of cancer. We have explored whether N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma levels predict a future diagnosis of cancer in patients with coronary artery disease (CAD).
  
  
  METHODS
  We studied 699 patients with CAD free of cancer. At baseline, NT-proBNP, galectin-3, monocyte chemoattractant protein-1, soluble tumor necrosis factor-like weak inducer of apoptosis, high-sensitivity C-reactive protein, and high-sensitivity cardiac troponin I plasma levels were assessed. The primary outcome was new cancer diagnosis. The secondary outcome was cancer diagnosis, heart failure requiring hospitalization, or death.
  
  
  RESULTS
  After 2.15±0.98 years of follow-up, 24 patients developed cancer. They were older (68.5 [61.5, 75.8] vs 60.0 [52.0, 72.0] years; p=0.011), had higher NT-proBNP (302.0 [134.8, 919.8] vs 165.5 [87.4, 407.5] pg/ml; p=0.040) and high-sensitivity C-reactive protein (3.27 [1.33, 5.94] vs 1.92 [0.83, 4.00] mg/L; p=0.030), and lower triglyceride (92.5 [70.5, 132.8] vs 112.0 [82.0, 157.0] mg/dl; p=0.044) plasma levels than those without cancer. NT-proBNP (Hazard Ratio [HR]=1.030; 95% Confidence Interval [CI]=1.008-1.053; p=0.007) and triglyceride levels (HR=0.987; 95%CI=0.975-0.998; p=0.024) were independent predictors of a new cancer diagnosis (multivariate Cox regression analysis). When patients in whom the suspicion of cancer appeared in the first one-hundred days after blood extraction were excluded, NT-proBNP was the only predictor of cancer (HR=1.061; 95%CI=1.034-1.088; p<0.001). NT-proBNP was an independent predictor of cancer, heart failure, or death (HR=1.038; 95%CI=1.023-1.052; p<0.001) along with age, and use of insulin and acenocumarol.
  
  
  CONCLUSIONS
  NT-proBNP is an independent predictor of malignancies in patients with CAD. New studies in large populations are needed to confirm these findings.
authors.affiliation: Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain; Autónoma University, Madrid, Spain; Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Tuñón
authors.affiliation: Department of Cardiology, Hospital Clínico Universitario San Carlos, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Higueras
authors.affiliation: Department of Cardiology, Hospital Universitario de Móstoles, Madrid, Spain.
authors.forename: Nieves
authors.initials: N
authors.lastname: Tarín
authors.affiliation: Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain; Rey Juan Carlos University, Alcorcón, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Cristóbal
authors.affiliation: Autónoma University, Madrid, Spain; Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Óscar
authors.initials: Ó
authors.lastname: Lorenzo
authors.affiliation: Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Blanco-Colio
authors.affiliation: Autónoma University, Madrid, Spain; Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Martín-Ventura
authors.affiliation: Department of Cardiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Huelmos
authors.affiliation: Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain; Rey Juan Carlos University, Alcorcón, Madrid, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Alonso
authors.affiliation: Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Aceña
authors.affiliation: Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Pello
authors.affiliation: Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Rocío
authors.initials: R
authors.lastname: Carda
authors.affiliation: Department of Biochemistry, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Dolores
authors.initials: D
authors.lastname: Asensio
authors.affiliation: Department of Preventive Medicine, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Mahíllo-Fernández
authors.affiliation: Rey Juan Carlos University, Alcorcón, Madrid, Spain.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: López Bescós
authors.affiliation: Autónoma University, Madrid, Spain; Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain; CIBERDEM, Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Egido
authors.affiliation: Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain; Autónoma University, Madrid, Spain.
authors.forename: Jerónimo
authors.initials: J
authors.lastname: Farré
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D003324:Coronary Artery Disease / Q000097:blood* / Q000150:complications / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D037502:Galectin 3 / Q000097:blood; D006333:Heart Failure / Q000175:diagnosis; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis*; D010446:Peptide Fragments / Q000097:blood*; D016016:Proportional Hazards Models; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; D037502:Galectin 3; D010446:Peptide Fragments; D014280:Triglycerides; D019210:Troponin I; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein