Associations of elevated levels of brain natriuretic peptide and heart failure and their contribution to survival in the Russian middle-aged population: data from the ESSE-RF study

Aim. To study the associations of elevated brain natriuretic peptide (BNP) and heart failure (HF) and their contribution to the survival of the middle-aged population.

Material and methods. The analysis included blood pressure levels and heart rate, anthropometric parameters and biochemical tests. BNP was determined on an Architect i2000sr analyzer (Abbot Diagnostics, USA). HF was diagnosed according to criteria close to the EPOCH-CHF study criteria: cardiovascular disease (CVD), weakness, shortness of breath. Survival analysis was performed for 5037 people from the ESSE-RF2 sample (Ryazan and Omsk regions, the Republic of Karelia, Krasnodar Territory). The analysis used a composite endpoint (n=143) of CVD death plus non-fatal myocardial infarction or cerebrovascular accident. The follow-up time was, on average, 3,82 [3,65-3,86] years.

Results. The prevalence of HF in the ESSE-RF2 sample aged 35-64 years was 7,9% according to our criteria, while a third of the participants were men (35,9%). The average age of the population was 45 [34; 55] years, which is significantly lower than the age of patients: 56 [50; 61] years. Almost 100% of patients with HF in our sample at this age were etiologically associated with hypertension (HTN) (94,1%), which is more than 2 times higher than in the population. A third of HF is due to coronary artery disease, which is 4 times higher than in the population. Similarly, the prevalence of cerebrovascular accident and diabetes exceeds their prevalence in the population. The detection rate of elevated BNP (>35 pg/ml) was 11,9% in the population, and 24,5% in the HF sample. An independent significant contribution of BNP >100 pg/ml was revealed, which can be characterized as the most powerful marker associated with HF. The relative risk was 3,21 [1,75-5,39]. Kaplan-Meier curves show higher survival of participants without HF and elevated BNP levels (>35 pg/ml) compared to other groups. There were no significant differences between the curves with HF and elevated BNP, while patients with HF in combination with an elevated BNP had a significantly lower survival rate. Analysis using Cox models indicates that patients with only HF or only with elevated BNP die ~2 times more often than those who do not have these signs. An increase in BNP along with HF has a cumulative effect: individuals with both high BNP and HF die 5 times more often than those who do not have these disorders at all, and ~2 times more often than those who have only one sign.

Conclusion. The obtained results indicate that an elevated level of BNP is a prognostically unfavorable factor at the population level. Although blood BNP levels are recommended to be measured in individuals with suspected CVD, we believe sufficient randomized controlled trials are needed to evaluate the potential use of BNP in individuals with risk factors. This can improve the diagnosis and, accordingly, the treatment and prognosis of HF.

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