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CLINICAL RESEARCH: VASCULAR RISK FACTOR

Glomerular Filtration Rate and N-Terminal Pro-Brain Natriuretic Peptide as Predictors of Cardiovascular Mortality in Vascular Patients

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.

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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