Environmental Health and Preventive Medicine (Apr 2021)

Urinary N-terminal pro–B-type natriuretic peptide as a biomarker for cardiovascular events in a general Japanese population: the Hisayama Study

  • Keisuke Yamasaki,
  • Jun Hata,
  • Tomomi Ide,
  • Takuya Nagata,
  • Satoko Sakata,
  • Daigo Yoshida,
  • Takanori Honda,
  • Yoichiro Hirakawa,
  • Toshiaki Nakano,
  • Takanari Kitazono,
  • Hiroyuki Tsutsui,
  • Toshiharu Ninomiya

DOI
https://doi.org/10.1186/s12199-021-00970-0
Journal volume & issue
Vol. 26, no. 1
pp. 1 – 10

Abstract

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Abstract Background Epidemiological evidence has shown that serum N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations, a diagnostic biomarker for heart failure, are positively associated with cardiovascular risk. Since NT-proBNP in serum is excreted in urine, it is hypothesized that urinary NT-proBNP concentrations are correlated with serum concentrations and linked with cardiovascular risk in the general population. Methods A total of 3060 community-dwelling residents aged ≥ 40 years without history of cardiovascular disease (CVD) were followed up for a median of 8.3 years (2007–2015). Serum and urinary concentrations of NT-proBNP at baseline were compared. The hazard ratios (HRs) and their 95% confidence intervals (CIs) for the association between NT-proBNP concentrations and the risk of developing CVD were computed using the Cox proportional hazards model. Results The median values (interquartile ranges) of serum and urinary NT-proBNP concentrations at baseline were 56 (32–104) pg/mL and 20 (18–25) pg/mL, respectively. There was a strong quadratic correlation between the serum and urinary concentrations of NT-proBNP (coefficient of determination [R 2] = 0.72): urinary concentrations of 20, 27, and 43 pg/mL were equivalent to serum concentrations of 55, 125, and 300 pg/mL, respectively. During the follow-up period, 170 subjects developed CVD. The age- and sex-adjusted risk of CVD increased significantly with higher urinary NT-proBNP levels (P for trend < 0.001). This association remained significant after adjustment for traditional cardiovascular risk factors (P for trend = 0.009). The multivariable-adjusted risk of developing CVD almost doubled in subjects with urinary NT-proBNP of ≥ 43 pg/mL as compared to those with urinary NT-proBNP of ≤ 19 pg/mL (HR 2.07, 95% CI 1.20–3.56). Conclusions The present study demonstrated that urinary NT-proBNP concentrations were well-correlated with serum concentrations and were positively associated with cardiovascular risk. Given that urine sampling is noninvasive and does not require specially trained personnel, urinary NT-proBNP concentrations have the potential to be an easy and useful biomarker for detecting people at higher cardiovascular risk.

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