Elevated N-terminal pro-brain natriuretic peptide is associated with mortality in tobacco smokers independent of airflow obstruction

• Published in: PloS one Vol. 6; no. 11; p. e27416
• Main Authors: Stamm, Jason A, Belloli, Elizabeth A, Zhang, Yingze, Bon, Jessica, Sciurba, Frank C, Gladwin, Mark T
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 07.11.2011; Public Library of Science (PLoS)
• Subjects: Aged; Air flow; Airflow; Analysis; Bioindicators; Biomarkers; Body mass; Body mass index; Body size; Brain; Brain natriuretic peptide; Cardiovascular disease; Cardiovascular diseases; Chronic obstructive pulmonary disease; Cohort Studies; Diagnostic systems; Female; Follow-Up Studies; Hazard assessment; Health aspects; Health risk assessment; Health risks; Humans; Inventions; Male; Medical diagnosis; Medicine; Middle Aged; Mortality; Natriuretic Peptide, Brain - analysis; Natriuretic Peptide, Brain - metabolism; Natriuretic peptides; Peptide Fragments - analysis; Peptide Fragments - metabolism; Prognosis; Proportional Hazards Models; Prospective Studies; Pulmonary Disease, Chronic Obstructive - etiology; Quality of life; Risk Factors; Risk reduction; Smokers; Smoking; Smoking - mortality; Tobacco; United States > US; Pittsburgh Pennsylvania; Pennsylvania
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0027416

Tobacco use is associated with an increased prevalence of cardiovascular disease. N-terminal pro-brain natiuretic peptide (NT-proBNP), a widely available biomarker that is associated with cardiovascular outcomes in other conditions, has not been investigated as a predictor of mortality in tobacco smokers. We hypothesized that NT-proBNP would be an independent prognostic marker in a cohort of well-characterized tobacco smokers without known cardiovascular disease. Clinical data from 796 subjects enrolled in two prospective tobacco exposed cohorts was assessed to determine factors associated with elevated NT-proBNP and the relationship of these factors and NT-proBNP with mortality. Subjects were followed for a median of 562 (IQR 252-826) days. Characteristics associated with a NT-proBNP above the median (≥49 pg/mL) were increased age, female gender, and decreased body mass index. By time-to-event analysis, an NT-proBNP above the median (≥49 pg/mL) was a significant predictor of mortality (log rank p = 0.02). By proportional hazard analysis controlling for age, gender, cohort, and severity of airflow obstruction, an elevated NT-proBNP level (≥49 pg/mL) remained an independent predictor of mortality (HR = 2.19, 95% CI 1.07-4.46, p = 0.031). Elevated NT-proBNP is an independent predictor of mortality in tobacco smokers without known cardiovascular disease, conferring a 2.2 fold increased risk of death. Future studies should assess the ability of this biomarker to guide further diagnostic testing and to direct specific cardiovascular risk reduction inventions that may positively impact quality of life and survival.