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B-type natriuretic peptide: distribution in the general population and the association with major cardiovascular and coronary events—The Heinz Nixdorf Recall Study

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Abstract

Background

A B-type natriuretic peptide (BNP) threshold of 100 pg/ml is used in practice for identification of heart failure, but data about the “normal” distribution of BNP in a large population in primary prevention are rare. We aimed to characterize the BNP distribution in a healthy subset of a population-based cohort and to evaluate the association of elevated BNP levels with major events.

Methods

In a first step, we determined gender-specific distribution and 90th percentiles of BNP in participants who were at baseline free from known determinants of increased BNP, i.e. cardiovascular disease, hypertension or chronic kidney disease. Consecutively, the association of BNP levels above these 90th percentiles with subsequent cardiovascular and coronary events was assessed in the entire cohort.

Results

In the BNP-normal sub-sample (n = 1,639), we defined gender-specific 90th percentile of BNP (31.3 pg/ml for men, 45.5 pg/ml for women). From overall 3,697 subjects (mean age 59.4, 52.4 % female), 194 subjects developed a major cardiovascular event and 122 myocardial infarction during a mean follow-up period of 8.0 ± 1.5 years. The 90th percentiles derived from the normal subset as threshold showed strong associations with major events in the entire cohort even after adjusting for traditional risk factors: hazard ratio (95 % CI): 1.86 (1.37; 2.53), p < 0.0001 for cardiovascular, and 1.77 (1.19; 2.62), p = 0.005 for coronary events.

Conclusion

The gender-specific 90th percentile of BNP (31 pg/ml for males and 45 pg/ml for females) obtained from a BNP-normal sub-sample is associated with incident major cardiovascular and coronary events, suggesting that even BNP values lower than 100 pg/ml could imply prognostic information in the general population.

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Acknowledgments

This study was supported by the Heinz Nixdorf Foundation (Chairman: Martin Nixdorf, past chairman: Dr Jur G. Schmidt), the German Ministry of Education and Science (BMBF), the German Research Council (DFG) (SI-236/8-1, SI-236/9-1, ER155/6-2) and the German Aerospace Centre (DLR). For BNP assays, the financial support of Siemens HealthCare Diagnostics (Eschborn, Germany) is gratefully acknowledged.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. The West-German Heart Center, Department of Cardiology, University of Duisburg-Essen, Essen, Germany

    Kaffer Kara, Amir A. Mahabadi, Hagen Kälsch, Marcus Bauer, Till Neumann & Raimund Erbel

  2. The Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany

    Marie H. Geisel, Nils Lehmann, Susanne Moebus & Karl-Heinz Jöckel

  3. Centre for Health and Society, Institute for Medical Sociology, University of Düsseldorf, Düsseldorf, Germany

    Nico Dragano

  4. Department of Cardiology, Krankenhaus Bethanien, Moers, Germany

    Stefan Möhlenkamp

  5. Cardiovascular Center, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany

    Kaffer Kara

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  1. Kaffer Kara
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Correspondence to Kaffer Kara.

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Kara, K., Mahabadi, A.A., Geisel, M.H. et al. B-type natriuretic peptide: distribution in the general population and the association with major cardiovascular and coronary events—The Heinz Nixdorf Recall Study. Clin Res Cardiol 103, 125–132 (2014). https://doi.org/10.1007/s00392-013-0628-4

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