N-terminal pro-brain natriuretic peptide and cardiovascular or all-cause mortality in the general population: A meta-analysis

Zhaohua Geng,Yaoming Song,Lan Huang,Mingbao Song

doi:10.1038/srep41504

Abstract

The prognostic role of N-terminal pro-brain natriuretic peptide (NT-proBNP) in the general population remains controversial. We conducted this meta-analysis to investigate the association between baseline NT-proBNP concentrations and cardiovascular or all-cause mortality in the general population. PubMed and Embase databases were systematically searched from their inception to August 2016. Prospective observational studies that investigated the association between baseline NT-proBNP concentrations and cardiovascular or all-cause mortality in the general population were eligible. A summary of the hazard ratio (HR) and 95% confidence interval (CI) of mortality were calculated by the highest versus the lowest category of NT-proBNP concentrations. Eleven studies with a total of 25,715 individuals were included. Compared individuals in the highest with those in the lowest category of NT-proBNP, the pooled HR was 2.44 (95% CI 2.11–2.83) for all-cause mortality, 3.77 (95% CI 2.85–5.00) for cardiovascular mortality, and 2.35 (95% CI 1.45–3.82) for coronary heart disease mortality, respectively. Subgroup analyses indicated that the effects of NT-proBNP on the risk of cardiovascular mortality (RR 2.27) and all-cause mortality (RR 3.00) appeared to be slightly lower among men. Elevated NT-proBNP concentrations appeared to be independently associated with increased risk of cardiovascular and all-cause mortality in the general population.

Highlights

NT-proBNP has been shown to predict poor prognosis in a variety of settings, including heart failure[18], acute coronary syndromes[19], stable coronary artery disease[20], or stroke[21]. This meta-analysis goes beyond these established cardiovascular diseases and especially extends to the setting of the general population
The current meta-analysis demonstrates that elevated NT-proBNP concentrations appeared to be independently associated with increased risk for Coronary heart disease (CHD), cardiovascular and all-cause mortality in the general population
Our subgroup analysis showed that the prognostic value of cardiovascular and all-cause mortality risk was stronger for participants with mean age ≥70 years than those with a mean age

Summary

Results

When compared with the lowest NT-proBNP concentrations, individuals with the highest concentrations of NT-proBNP were associated with greater risk of cardiovascular mortality (HR 3.77; 95% CI 2.85–5.00) in a random-effects model. Subgroup analyses indicated that the association between elevated NT-proBNP concentrations and risk of cardiovascular and all-cause mortality was consistently observed in each subgroup (Table 2). The risk of cardiovascular and all-cause mortality was higher in studies with a follow-up duration ≤5 years or mean age ≥7 0 years. The risk of cardiovascular and all-cause mortality was lower in studies enrolling only men or use of NT-proBNP cutoff value. Sex, race, smoking, TC, HDL, SBP, hypertension., DB, BMI, CHD, renal function, any major ECG abnormality, use of ACEIs/ARBs, beta-blockers, and diuretics. Sex, current smoking, BMI, SBP, DBP, FBG, TC, HDL-C, LDL-C, eGFR, highsensitivity CRP, and homocysteine

Discussion

Cardiovascular mortality

Methods