Can measurement of B-type natriuretic peptide levels improve cardiovascular disease prevention?

1. The measurement of plasma levels of B-type natriuretic peptide (BNP) and amino-terminal pro-BNP (NT-proBNP) provides useful diagnostic information in patients with suspected heart failure and valuable prognostic information in patients with heart failure, acute coronary syndrome, valvular heart disease and other cardiac pathologies. 2. BNP- and NT-proBNP-guided heart failure therapy improves patient outcomes. 3. An increasing number of studies shows plasma BNP and NT-proBNP levels predict all-cause mortality and cardiovascular events including heart failure, myocardial infarction, stroke, atrial fibrillation and cardiovascular death in stable patients with or without known cardiovascular disease and provide information about cardiovascular risk additional to that provided by traditional risk factors. 4. Antihypertensive therapy reduces elevated NT-proBNP levels in individuals at increased cardiovascular risk, thereby suggesting that change in NT-proBNP levels provides a measure of risk reduction. 5. Thus, monitoring of BNP and NT-proBNP levels offers the possibilities of improved targeting of individuals with increased cardiovascular risk and optimization of strategies for primary and secondary prevention of cardiovascular disease. 6. There is need for an outcome study to determine whether BNP- or NT-proBNP-guided therapy improves cardiovascular disease prevention.