CLINICAL RESEARCH: VASCULAR RISK FACTOR
Glomerular Filtration Rate and N-Terminal Pro-Brain Natriuretic Peptide as Predictors of Cardiovascular Mortality in Vascular Patients
Ramin Shadman, MD,
Matthew A. Allison, MD, MPH and
Michael H. Criqui, MD, MPH*
University of California San Diego, San Diego, California.
Manuscript received October 10, 2006;
revised manuscript received February 1, 2007,
accepted February 6, 2007.
* Reprint requests and correspondence: Dr. Michael H. Criqui, Department of Family and Preventive Medicine, University of California San Diego, 9500 Gilman Drive, 352 SCRB, La Jolla, California 92093. (Email: mcriqui{at}ucsd.edu).
Objectives: The purpose of this work was to assess the prognostic role of glomerular filtration rate (GFR) and NT-terminal pro-B-type natriuretic peptide (NT-proBNP) for mortality end points in the vascular population.
Background: The GFR and NT-proBNP have been shown to predict mortality end points in free-living and limited vascular populations, independent of traditional risk factors. However, their prognostic power in an unrestricted vascular population is poorly understood.
Methods: A total of 412 subjects from a vascular cohort with a history of either peripheral arterial disease (PAD) and/or other cardiovascular disease (CVD) were included in this prospective cohort analysis and followed for an average of 6.7 years. Outcome variables were all-cause mortality, ischemic heart disease (IHD) mortality, and any cardiovascular mortality. The prognostic roles of GFR and NT-proBNP levels were determined using multivariate survival analysis.
Results: Higher GFR (per 10 ml/min/1.73 m2) was significantly protective for all-cause mortality (hazard ratio [HR] 0.81, p < 0.001), IHD mortality (HR 0.82, p = 0.008), and CVD mortality (HR 0.84, p = 0.005). Conversely, NT-proBNP was not a significant predictor of any mortality end point. The GFR showed the strongest association in subjects with a history of other CVD. Although NT-proBNP did not demonstrate a significant prognostic role in any of the subgroups, the data were suggestive for patients with PAD alone.
Conclusions: Glomerular filtration rate was a robust predictor of all-cause, IHD, and cardiovascular mortality in the vascular population, particularly in those with a history of other CVD, while NT-proBNP showed a suggestive association limited to the group with PAD only. These findings suggest that these markers must be selectively applied in the vascular population for greatest clinical utility.
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Abbreviations and Acronyms
| | ABI = ankle-brachial index | | ACE = angiotensin-converting enzyme | | BNP = B-type natriuretic peptide | | CHF = congestive heart failure | | CVD = cardiovascular disease | | GFR = glomerular filtration rate | | HDL = high-density lipoprotein | | HR = hazard ratio | | ICD-9 = International Classification of Diseases, Ninth Revision | | IHD = ischemic heart disease | | MDRD = Modification of Diet in Renal Disease | | NT-proBNP = N-terminal pro-B-type natriuretic peptide | | PAD = peripheral arterial disease |
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