Natriuretic peptides, novel biomarkers, and the prediction of future events

Abstract

This editorial refers to ‘N-terminal pro-B-type natriuretic peptide and the prediction of primary cardiovascular events: results from 15-year follow-up of WOSCOPS’, by P. Welsh et al. , doi:10.1093/eurheartj/ehs239 Since their establishment as pillars of heart failure (HF) diagnosis, the role of natriuretic peptides (NPs) in clinical medicine has been growing impressively. This remarkable family of proteins includes B-type natriuretic peptide (BNP), N-terminal proBNP (NT-proBNP), and atrial natriuretic peptide (ANP). NPs are released by the ventricular myocardium in response to wall stress, and function as protective hormones that antagonize the pathophysiology of HF. Their functions include increasing the glomerular filtration rate, up-regulating sodium and water excretion, increasing vasodilation, preventing cardiac hypertrophy, and inhibiting the renin–aldosterone system.1 While Sudoh et al. first isolated BNP in 1988, its role as a HF biomarker was not fully recognized until 2002 by the multicentre Breathing Not Properly trial. This study set BNP's accuracy of HF diagnosis at 100 pg/mL to be 83.4%, with a negative predictive value of 96% at a cut-off of 50 pg/mL.2 Years later, Januzzi et al. solidified NT-proBNP in the acute setting in the PRIDE study.3 Since then, the repertoire of these biomarkers has expanded into areas of risk stratification and treatment guidance. The potential to risk stratify those with clinically evident cardiovascular disease (CVD) and perhaps even those who have yet to develop it is certainly an important task. Indeed, in the current phase of their clinical evolution, NPs are being actively researched as possible screening tools for asymptomatic people in the outpatient setting. If validated, these markers, perhaps in the company of other novel biomarkers, could allow those at risk for CVD without classic risk factors such as hypertension, diabetes mellitus, and hyperlipidaemia to be identified and treated before the appearance of full-on CVD⇓. Figure 1 Classic …