B-Type Natriuretic Peptides and Cardiovascular Risk Systematic Review and Meta-Analysis of 40 Prospective Studies
B-Type Natriuretic Peptides and Cardiovascular Risk Systematic Review and Meta-Analysis of 40 Prospective Studies
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DOI：
10.1161/circulationaha.109.884866
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发表时间：
2009-12-01
期刊：
影响因子：
37.8
通讯作者：
Danesh, John
中科院分区：
文献类型：
--
作者：
Di Angelantonio, Emanuele;Chowdhury, Rajiv;Danesh, John
背景-建议在有左心功能不全症状和其他环境的患者中测量B型利钠肽(BNP)或其前体(N-末端片段[NT-proBNP])的浓度，但在普通人群或稳定性血管疾病患者中，这些多肽与心血管疾病(CVD)的相关性尚不确定。方法和结果-整理了40项长期前瞻性研究的数据，涉及总计87 474名参与者和10 625例心血管疾病结果。在比较钠尿肽基准值的前三分之一和后三分之一的个体中，经几个常规危险因素调整后的合并危险比(RR)为2.82(95%可信区间[CI]，2.40至3.33)。对6项至少有250项心血管疾病结果的研究(与较小的研究相比，选择性报告的可能性较小)的分析得出调整后的RR为1.94(95%可信区间为1.57至2.39)。在一般人群中，RR与BNP或NT-proBNP大致相似(RR，分别为2.89[95%CI，1.91~4.38]和2.82[95%CI，2.35~3.38])，但具有不同的基线血管风险(RR，2.68[95%CI，2.07~3.47]；在血管危险因素升高的人群中，RR，3.35[95%CI，2.38~4.72]；在稳定的CVD患者中，RR，2.60[95%CI，1.99~3.38])。BNP或NT-proBNP的测定与传统的心血管危险因素的测定相比，在风险辨别方面的改善一般不大。结论：现有的前瞻性研究表明，在一系列不同的情况下，循环中的钠尿肽浓度与心血管疾病风险之间存在很强的相关性。有必要进行进一步的研究，特别是在大规模的一般人群研究中，以澄清这些标记的任何预测作用，并更好地控制发表偏倚。(发行量。2009；120：2177-2187。)
Background-Measurement of B-type natriuretic peptide (BNP) concentration or its precursor (N-terminal fragment [NT-proBNP]) is recommended in patients with symptoms of left ventricular dysfunction and in other settings, but the relevance of these peptides to cardiovascular disease (CVD) in general populations or in patients with stable vascular disease is uncertain.Methods and Results-Data were collated from 40 long-term prospective studies involving a total of 87 474 participants and 10 625 incident CVD outcomes. In a comparison of individuals in the top third with those in the bottom third of baseline values of natriuretic peptides, the combined risk ratio (RR), adjusted for several conventional risk factors, was 2.82 (95% confidence interval [CI], 2.40 to 3.33) for CVD. Analysis of the 6 studies with at least 250 CVD outcomes (which should be less prone to selective reporting than are smaller studies) yielded an adjusted RR of 1.94 (95% CI, 1.57 to 2.39). RRs were broadly similar with BNP or NT-proBNP (RR, 2.89 [95% CI, 1.91 to 4.38] and 2.82 [95% CI, 2.35 to 3.38], respectively) and by different baseline vascular risk (RR, 2.68 [95% CI, 2.07 to 3.47] in approximately general populations; RR, 3.35 [95% CI, 2.38 to 4.72] in people with elevated vascular risk factors; RR, 2.60 [95% CI, 1.99 to 3.38] in patients with stable CVD). Assay of BNP or NT-proBNP in addition to measurement of conventional CVD risk factors yielded generally modest improvements in risk discrimination.Conclusions-Available prospective studies indicate strong associations between circulating concentration of natriuretic peptides and CVD risk under a range of different circumstances. Further investigation is warranted, particularly in large general population studies, to clarify any predictive utility of these markers and to better control for publication bias. (Circulation. 2009; 120: 2177-2187.)