What are the findings of the Framingham Heart Study related to the efficacy of brain natriuretic peptide (BNP) assays?

Updated: Jan 08, 2018
  • Author: Donald Schreiber, MD, CM; Chief Editor: Erik D Schraga, MD  more...
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In a prospective study, researchers evaluated 3346 patients without heart failure from the Framingham Heart Study to determine the usefulness of BNP in predicting the risks for all-cause mortality, CHF, acute coronary syndrome (ACS), atrial fibrillation (AF), and stroke or transient ischemic attack (TIA). [6] Patients were followed up for a mean period of 5.2 years.

After adjustment for known cardiovascular risk factors, high levels of BNP were associated with a 27% increase in risk of all-cause mortality, a 28% increase in risk for a first cardiovascular event, a 77% increase in the risk of CHF, a 66% increase in the risk of AF, and a 50% increase in the risk of stroke or TIA.

A surprising finding was that BNP levels were not predictive of coronary heart disease. BNP levels greater than the 80th percentile (20pg/mL for men, 23pg/mL for women) were significantly associated with multivariable-adjusted hazard ratios of 1.6 for death, 1.8 for a first major cardiovascular event, 1.9 for atrial fibrillation, 2.0 for stroke or TIA, and 3.1 for heart failure.

These values were well below the proposed cutoff of 100pg/mL to rule out CHF in emergency department (ED) patients with dyspnea. However, they raise the issue of whether BNP testing has a role in risk stratification and screening for cardiovascular and cerebrovascular disease in asymptomatic populations.

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