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

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@*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.

How to Treat the “Real World” Patients with Heart Failure / 薬剤疫学

Previous basic, clinical, and population sciences have advanced the modern treatment of heart failure. However, its efficacy is still limited especially in the “real world” patients. The clinical characteristics and prognosis of patients with heart failure have been described by a number of previous studies, which have been performed mainly in the United States and Europe. Very little information is available on this issue in Japan. We determined the clinical characteristics and prognosis of 230 patients consecutively hospitalized with HF at 5 teaching hospitals in Fukuoka, Japan in 1997. Patients were elderly and made up of a larger population of women especially at a higher age. The major causes of heart failure were ischemic, valvular, and hypertensive : 35% of HF patients had a normal ejection fraction by echocardiography, in which heart failure might be mainly attributable to diastolic dysfunction. Readmission due to the exacerbation of heart failure is common. Noncomplicance to the treatment is the most common precipitating factor for readmission. Regular medical follow-up and social support are important for the disease management program of heart failure. A nationwide survey of the “real world” patients needs to be performed in Japan to establish the most effective and efficient treatment strategies.