The N-terminal fragment of the prohormone brain natriuretic peptide
(NT-proBNP) is a stronger predictor of cardiovascular disease and
death than is C-reactive protein (CRP) in older adults, according to
a report in the Journal of the American Medical Association for
April 6th.

Previous reports have linked plasma levels of B-type natriuretic
peptides with cardiovascular disease, but it has been unclear how
their predictive value stacked up against CRP.

To investigate, Dr. Caroline Kistorp, from Frederiksberg University
Hospital in Copenhagen, and colleagues assessed the predictive value
of both biomarkers in 537 subjects between 50 and 89 years of age
with no cardiovascular disease at baseline.

During 5-year follow-up, 94 subjects died and 65 experienced a first
major cardiovascular event, the authors note.

After adjusting for traditional cardiovascular risk factors, the NT-
proBNP level was stronger than CRP or the urinary albumin/creatinine
ratio at predicting cardiovascular disease or death. Compared with
lower values, an NT-proBNP level above the 80th percentile raised
the risk of death by 96%. For CRP and the urinary albumin/creatinine
ratio, the elevated risks were 46% and 88%, respectively.

Even after accounting for left ventricular systolic dysfunction, the
NT-proBNP level was a robust predictor of death, the investigators
note.

Using the 80th percentile as a cutoff again, NT-proBNP levels above
this threshold were linked to a 3.24-fold increased risk of a first
major cardiovascular event. By contrast, the hazard ratios seen with
CRP and the urinary albumin/creatinine ratio were lower-1.02 and
2.32, respectively.

"NT-proBNP was a better predictor than both CRP and urinary albumin
with respect to all of the outcomes, and CRP did not provide
prognostic information beyond traditional risk factors," the authors
state.

Although the findings are encouraging, "several issues remain to be
addressed before NT-proBNP can be applied for routine screening
purposes, including the issues of optimal cutoff values and whether
specific treatment benefits patients with increased NT-proBNP
levels," Dr. Martin Schillinger, from the University of Vienna,
notes in a related editorial.

JAMA 2005;293:1609-1616,1667-1669