Comparison of midregional pro-A-type natriuretic peptide and the N-terminal pro-B-type natriuretic peptide for predicting mortality and cardiovascular events

• Published in: Clinical chemistry (Baltimore, Md.) Vol. 58; no. 1; pp. 293 - 297
• Main Authors: van Hateren, Kornelis J J, Alkhalaf, Alaa, Kleefstra, Nanne, Groenier, Klaas H, de Jong, Paul E, de Zeeuw, Dick, Gans, Rijk O B, Struck, Joachim, Bilo, Henk J G, Gansevoort, Ron T, Bakker, Stephan J L
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.01.2012
• Subjects: Adult; Aged; Atrial Natriuretic Factor - blood; Biomarkers - blood; Cardiovascular disease; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - mortality; Drug therapy; Female; Health risks; Heart attacks; Heart failure; Humans; Male; Middle Aged; Mortality; Natriuretic Peptide, Brain - blood; Observational studies; Peptide Fragments - blood; Peptides; Population studies; Predictive Value of Tests; Proportional Hazards Models; Prospective Studies; Protein Precursors - blood; Risk factors; Studies
• ISSN: 0009-9147; 1530-8561
• DOI: 10.1373/clinchem.2011.166348

N-terminal pro-B-type natriuretic peptide (NT-proBNP) provides prognostic information on mortality and future cardiovascular events for individuals from the general population. A novel immunoassay was recently developed that measures a midregional fragment of pro-A-type natriuretic peptide (MR-proANP). We compared the capabilities of MR-proANP and NT-proBNP for predicting mortality and cardiovascular events in a population-based study. A total of 7819 patients participated in the population-based Prevention of Renal and Vascular End-stage Disease (PREVEND) study, a prospective observational study. Three clinical end points were studied: all-cause mortality, cardiovascular mortality, and cardiovascular events. After a median follow-up of 10.5 years, we used a Cox proportional hazards model to investigate the relationship between the 2 natriuretic peptides and the clinical end points. The Harrell C statistic and the integrated discrimination improvement (IDI) were used to compare MR-proANP and NT-proBNP. Increased plasma concentrations of both natriuretic peptides were associated with an increased risk of all-cause mortality and cardiovascular events, after adjustment for age, sex, and other cardiovascular risk factors. According to the Harrell C statistic analysis, the models with MR-proANP and NT-proBNP were comparable in predicting all-cause mortality, cardiovascular mortality, and cardiovascular events. In contrast to NT-proBNP, MR-proANP was not independently related to cardiovascular mortality. In all models, the IDI was higher for NT-proBNP than for MR-proANP. MR-proANP was as efficient as NT-proBNP in predicting all-cause mortality, cardiovascular mortality, and cardiovascular events; however, its association with cardiovascular mortality was not independent from other confounders.