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

Eur J Heart Fail. 2013 Aug;15(8):859-67. doi: 10.1093/eurjhf/hft048. Epub 2013 Apr 7.

Abstract

Aims: 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).

Methods and 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).

Conclusion: 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.

Keywords: 10-year-follow-up; Echocardiography; Heart failure; Hypertension; LV hypertrophy; Natriuretic peptides.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use*
  • Adult
  • Aged
  • Aging / blood*
  • Biomarkers / blood
  • Body Mass Index
  • Cohort Studies
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / epidemiology
  • Echocardiography
  • Female
  • Germany / epidemiology
  • Heart Atria / diagnostic imaging
  • Heart Ventricles / diagnostic imaging
  • Humans
  • Hypertrophy, Left Ventricular / blood*
  • Hypertrophy, Left Ventricular / epidemiology
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Infarction / blood*
  • Myocardial Infarction / epidemiology
  • Natriuretic Peptide, Brain / blood*
  • Organ Size
  • Peptide Fragments / blood*
  • Regression Analysis
  • Sex Factors

Substances

  • Adrenergic beta-Antagonists
  • Biomarkers
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain