Michihiro Satoh1, Takahisa Murakami1,2, Kei Asayama3,4, Takuo Hirose5, Masahiro Kikuya6, Ryusuke Inoue7, Megumi Tsubota-Utsugi8, Keiko Murakami3, Ayako Matsuda3, Azusa Hara9, Taku Obara6,10, Ryo Kawasaki11,12, Kyoko Nomura13, Hirohito Metoki1,4,14, Koichi Node15, Yutaka Imai4, Takayoshi Ohkubo3,4. 1. Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University. 2. Division of Aging and Geriatric Dentistry, Department of Oral Function and Morphology, Tohoku University Graduate School of Dentistry. 3. Department of Hygiene and Public Health, Teikyo University School of Medicine. 4. Tohoku Institute for Management of Blood Pressure. 5. Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University. 6. Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University. 7. Department of Medical Information Technology Center, Tohoku University Hospital. 8. Department of Hygiene and Preventive Medicine, Iwate Medical University School of Medicine. 9. Department of Social Pharmacy and Public Health, Showa Pharmaceutical University. 10. Department of Pharmaceutical Sciences, Tohoku University Hospital. 11. Department of Vision Informatics (Topcon), Osaka University Graduate School of Medicine. 12. Department of Public Health, Yamagata University Graduate School of Medical Science. 13. Department of Public Health, Akita University Graduate School of Medicine. 14. Department of Community Medical Supports, Tohoku Medical Megabank Organization, Tohoku University. 15. Department of Cardiovascular Medicine, Saga University.
Abstract
BACKGROUND: N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been used for risk stratification in heart failure or acute coronary syndrome, but the beyond 5-year predictive value of NT-proBNP for stroke remains an unsettled issue in Asian patients. The aim of the present study was to clarify this point.Methods and Results: We followed 1,198 participants (33.4% men; mean age, 60.5±11.1 years old) in the Japanese general population for a median of 13.0 years. A first stroke occurred in 93 participants. Referencing previous reports, we stratified participants according to NT-proBNP 30.0, 55.0, and 125.0 pg/mL. Using the NT-proBNP <30.0 pg/mL group as a reference, adjusted HR for stroke (95% CI) in the NT-proBNP 30.0-54.9-pg/mL, 55.0-124.9-pg/mL, and ≥125.0-pg/mL groups were 1.92 (0.94-3.94), 1.77 (0.85-3.66), and 1.99 (0.86-4.61), respectively. With the maximum follow-up period set at 5 years, the hazard ratio of the NT-proBNP≥125.0-pg/mL group compared with the <30.0-pg/mL group increased significantly (HR, 4.51; 95% CI: 1.03-19.85). On extension of the maximum follow-up period, however, the association between NT-proBNP and stroke risk weakened. CONCLUSIONS: NT-proBNP was significantly associated with an elevated stroke risk. Given, however, that the predictive power decreased with the number of years after NT-proBNP measurement, NT-proBNP should be re-evaluated periodically in Asian patients.
BACKGROUND: N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been used for risk stratification in heart failure or acute coronary syndrome, but the beyond 5-year predictive value of NT-proBNP for stroke remains an unsettled issue in Asian patients. The aim of the present study was to clarify this point.Methods and Results: We followed 1,198 participants (33.4% men; mean age, 60.5±11.1 years old) in the Japanese general population for a median of 13.0 years. A first stroke occurred in 93 participants. Referencing previous reports, we stratified participants according to NT-proBNP 30.0, 55.0, and 125.0 pg/mL. Using the NT-proBNP <30.0 pg/mL group as a reference, adjusted HR for stroke (95% CI) in the NT-proBNP 30.0-54.9-pg/mL, 55.0-124.9-pg/mL, and ≥125.0-pg/mL groups were 1.92 (0.94-3.94), 1.77 (0.85-3.66), and 1.99 (0.86-4.61), respectively. With the maximum follow-up period set at 5 years, the hazard ratio of the NT-proBNP≥125.0-pg/mL group compared with the <30.0-pg/mL group increased significantly (HR, 4.51; 95% CI: 1.03-19.85). On extension of the maximum follow-up period, however, the association between NT-proBNP and stroke risk weakened. CONCLUSIONS: NT-proBNP was significantly associated with an elevated stroke risk. Given, however, that the predictive power decreased with the number of years after NT-proBNP measurement, NT-proBNP should be re-evaluated periodically in Asian patients.