N-terminal Pro-B-type natriuretic peptide, vascular disease risk, and cholesterol reduction among 20,536 patients in the MRC-BHF heart protection study.Report as inadecuate




N-terminal Pro-B-type natriuretic peptide, vascular disease risk, and cholesterol reduction among 20,536 patients in the MRC-BHF heart protection study. - Download this document for free, or read online. Document in PDF available to download.

Reference: Emberson, JR, Ng, LL, Armitage, J et al., (2007). N-terminal Pro-B-type natriuretic peptide, vascular disease risk, and cholesterol reduction among 20,536 patients in the MRC/BHF heart protection study. Journal of the American College of Cardiology, 49 (3), 311-319.Citable link to this page:

 

N-terminal Pro-B-type natriuretic peptide, vascular disease risk, and cholesterol reduction among 20,536 patients in the MRC/BHF heart protection study.

Abstract: OBJECTIVES: We sought to assess the ability of N-terminal pro-B-type natriuretic peptide (N-BNP) to predict vascular events in high-risk people and to test whether statins benefit people with high levels of N-BNP. BACKGROUND: The predictive value of N-BNP for occlusive vascular events and the effects of statins in people with high N-BNP levels are uncertain. METHODS: A total of 20,536 people were assigned randomly to simvastatin 40 mg daily or placebo for an average of 5 years. Five baseline N-BNP groups were defined ( andlt; 386; 386 to 1,171; 1,172 to 2,617; 2,618 to 5,758; and > or =5,759 pg/ml). RESULTS: Baseline N-BNP was strongly predictive of future vascular events independently of other characteristics. Compared with participants with N-BNP andlt; 386 pg/ml, those with levels > or =5,759 pg/ml had adjusted relative risks for major vascular events (MVEs) (i.e., major coronary events [MCE] [nonfatal myocardial infarction or coronary death], stroke, or revascularization) of 2.26, for MCE of 3.09, for stroke of 1.80, and for heart failure (hospitalization or death) of 9.23 (all p andlt; 0.0001). Overall, simvastatin allocation reduced the relative risk of MVE by 24% (95% confidence interval 19 to 28). There was a trend toward smaller (but still significant) proportional reductions in MVE among participants with greater baseline N-BNP levels, but the absolute benefits of simvastatin allocation were similar at all N-BNP levels. Simvastatin allocation was also associated with a 14% (95% confidence interval 0 to 25) proportional reduction in heart failure. No excess risk of other vascular and nonvascular outcomes was observed with simvastatin allocation among participants with greater baseline values of N-BNP. CONCLUSIONS: In this study, N-BNP levels were strongly predictive not only of heart failure but also of MVEs. In people with high N-BNP levels consistent with heart failure, statin allocation significantly reduced vascular risk, with no evidence of hazard. (http://www.controlledtrials.com/ISRCTN48489393/48489393).

Peer Review status:Peer reviewedPublication status:PublishedVersion:Publisher version Funder: Medical Research Council   Funder: British Heart Foundation   Funder: Merck and Co.   Funder: Roche Vitamins Ltd.   Notes:Copyright 2007 the American College of Cardiology Foundation. Published by Elsevier B.V. All rights reserved. Re-use of this article is permitted in accordance with the Terms and Conditions set out at http://www.elsevier.com/open-access/userlicense/1.0/

Bibliographic Details

Publisher: Elsevier B.V.

Publisher Website: http://www.elsevier.com/

Journal: Journal of the American College of Cardiologysee more from them

Publication Website: http://www.sciencedirect.com/science/journal/07351097

Issue Date: 2007-1

pages:311-319Identifiers

Urn: uuid:36f306e8-24e3-4853-b17a-1a3082a28236

Source identifier: 33731

Eissn: 1558-3597

Doi: https://doi.org/10.1016/j.jacc.2006.08.052

Issn: 0735-1097 Item Description

Type: Journal article;

Language: eng

Version: Publisher versionKeywords: Heart Protection Study Collaborative Group Humans Myocardial Infarction Cardiovascular Diseases Simvastatin Natriuretic Peptide, Brain Treatment Outcome Drug Administration Schedule Severity of Illness Index Confidence Intervals Linear Models Probability Risk Assessment Chi-Square Distribution Hypercholesterolemia Adult Aged Aged, 80 and over Heart Failure Stroke Middle Aged Female Follow-Up Studies Male Tiny URL: pubs:33731

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Author: Emberson, JR - - - Ng, LL - - - Armitage, J - - - Bowman, L - - - Parish, S - institutionUniversity of Oxford Oxford, MSD, Clinic

Source: https://ora.ox.ac.uk/objects/uuid:36f306e8-24e3-4853-b17a-1a3082a28236



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