Elevated plasma levels of NT-proBNP in ambulatory patients with peripheral arterial disease.

John Harlock,Abdelrahman Zamzam,Krishna K. Singh,Bader Alsuwailem,Muzammil H. Syed,Mohammed Al-Omran,Vincenzo Lionetti,Charles de Mestral,Rawand Abdin,Mark Wheatcroft,Elisa Greco,John Eikelboom,Mohammad Qadura

doi:10.1371/journal.pone.0253792

Abstract

N-terminal pro B-type natriuretic peptide (NT-proBNP), a cardiac disease biomarker, has been demonstrated to be a strong independent predictor of cardiovascular events in patients without heart failure. Patients with peripheral arterial disease (PAD) are at high risk of cardiovascular events and death. In this study, we investigated levels of NT-proBNP in patients with PAD compared to non-PAD controls. A total of 355 patients were recruited from outpatient clinics at a tertiary care hospital network. Plasma NT-proBNP levels were quantified using protein multiplex. There were 279 patients with both clinical and diagnostic features of PAD and 76 control patients without PAD (non-PAD cohort). Compared with non-PAD patients, median (IQR) NT-proBNP levels in PAD patients were significantly higher (225 ng/L (120–363) vs 285 ng/L (188–425), p- value = 0.001, respectively). Regression analysis demonstrated that NT-proBNP remained significantly higher in patients with PAD relative to non-PAD despite adjusting for age, sex, hypercholesterolemia, smoking and hypertension [odds ratio = 1.28 (1.07–1.54), p-value <0.05]. Subgroup analysis showed elevated NT-proBNP levels in patients with PAD regardless of prior history of CHF, CAD, diabetes and hypercholesteremia (p-value <0.05). Finally, spearmen’s correlation analysis demonstrated a negative correlation between NT-proBNP and ABI (ρ = -0.242; p-value < 0.001). In conclusion, our data shows that patients with PAD in an ambulatory care setting have elevated levels of NT-proBNP compared to non-PAD patients in the absence of cardiac symptoms.

Highlights

Peripheral artery disease (PAD) is a chronic cardiovascular condition that is more prevalent with aging
Since NT-proBNP is elevated in patients with stable cardiac disease [24], this study aims to assess the status of NTproBNP in ambulatory patients with PAD in the absence of acute coronary artery disease and acute congestive heart failure
Our analysis shows that PAD patients have higher levels of NTproBNP than non-PAD patients, irrespective of prior history of CHF or CAD, hypertension, diabetes and hypercholesteremia

Summary

Introduction

Peripheral artery disease (PAD) is a chronic cardiovascular condition that is more prevalent with aging. Patients with PAD suffer from a high risk of cardiovascular events and mortality [3,5]. The association between PAD and coronary artery disease is well established [6]. Progressive PAD has been shown to be an independent predictor of coronary and cerebrovascular morbidity and mortality [7]. Despite the strong association between PAD and cardiovascular morbidity, cardiovascular risk factors in patients with PAD are less intensively managed than in patients with coronary artery disease [11]. This inadequacy of medical management within patients with PAD is associated with increased risk of major adverse cardiovascular events

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