B‐type Natriuretic Peptides for the Prediction of Cardiovascular Events in Patients With Stable Coronary Heart Disease: The Heart and Soul Study

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Abstract
Background: Brain‐type natriuretic peptide ( BNP ) and the amino‐terminal fragment of its prohormone ( NT ‐pro BNP ) are known predictors of cardiovascular outcomes in patients with coronary heart disease; however, the relative prognostic value of these 2 biomarkers for secondary events remains unclear. Methods and Results: In 983 participants with stable coronary heart disease , we evaluated the association of BNP and NT ‐pro BNP with time to hospitalization for heart failure, nonfatal myocardial infarction, stroke or transient ischemic attack, cardiovascular death, and combined major adverse cardiovascular events ( MACE ). During an average follow‐up of 6.5±3.3 years, both BNP and NT ‐pro BNP were associated with increased risk of MACE in a multivariable‐adjusted model (hazard ratio per standard deviation of log BNP : 1.58; 95% CI: 1.32 to 1.89; hazard ratio per standard deviation of log NT ‐proBNP: 1.84; 95% CI: 1.52 to 2.24). When added to traditional risk factors, NT ‐pro BNP predicted MACE better than BNP (C statistic: 0.76 versus 0.72, P <0.001). Similarly, the addition of NT ‐pro BNP resulted in a greater net reclassification improvement for predicting MACE than the addition of BNP (65% for NT ‐pro BNP , 56% for BNP ). Conclusions: Both BNP and NT ‐pro BNP were significant predictors of MACE in stable coronary heart disease ; however, NT ‐pro BNP was superior to BNP for net risk reclassification for MACE .

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