natriuretic-peptide--brain and Hypercholesterolemia

Topics: Age Factors; Almanacs as Topic; Aortic Valve Insufficiency; Aortic Valve Stenosis; Austria; Biomarkers; Biomedical Research; Cardiac Surgical Procedures; Cardiology; Endocarditis; Fluorobenzenes; Heart Valve Diseases; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypercholesterolemia; Mitral Valve Insufficiency; Natriuretic Agents; Natriuretic Peptide, Brain; Periodicals as Topic; Prevalence; Prognosis; Pyrimidines; Randomized Controlled Trials as Topic; Risk Factors; Rosuvastatin Calcium; Severity of Illness Index; Smoking; Sulfonamides; Tricuspid Valve Insufficiency

The results of several large therapeutic cardiovascular trials were reported in 2002. The LIFE study concluded that losartan is superior compared to atenolol in terms of prevention of cardiovascular morbidity and mortality, the benefit being for CVA without changing the incidence of myocardial infarction. The OPTIMAAL study stated the disappointing results of post-infarct losartan. The IONA study represents a first demonstration with nicorandil of benefit not only in angina crises but equally on cardiac morbidity and mortality. The HPS study confirms the benefit of a statin in secondary prevention but for the first time, no matter what the initial level of LDL-cholesterol. Finally in the LIPS study, it is reported that statins reduce major cardiovascular events after coronary angioplasty. The year 2002 was marked elsewhere by imagination after the publication of the RAVEL study on coated stents delivering anti-proliferative drugs in order to avoid coronary restenosis. Three drugs were the subject of work confirming their potential significance in cardiovascular pathology: a) ezetimibe, representing a new class of cholesterol lowering drugs with which the association with statins seems especially synergic, b) nesiritide recombinant type B natriuretic peptide, whose significance was confirmed in acute cardiac insufficiency. c) levosimendan (calcium sensitisor) which moreover can be a significant treatment in cardiac decompensation as suggested by the LIDO study with a follow up of 180 days. By contrast, omapatrilate did not confirm its potential superiority over ACE inhibitors in the treatment of cardiac insufficiency. Some encouraging data were reported in 2002 in the field of therapeutic angiogenesis as much at the myocardial level as in lower limb arteritis. Finally, 2002 was marked by the publication of the WHI study which intensified suspicions regarding hormonal substitution treatment, confirming the advantage of not only secondary but perhaps primary cardiovascular prevention.

Topics: Anticholesteremic Agents; Antihypertensive Agents; Azetidines; Cardiovascular Diseases; Ezetimibe; Hormone Replacement Therapy; Humans; Hydrazones; Hypercholesterolemia; Losartan; Myocardial Infarction; Natriuretic Agents; Natriuretic Peptide, Brain; Neovascularization, Physiologic; Nicorandil; Pyridazines; Randomized Controlled Trials as Topic; Simendan; Vasodilator Agents

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.. The predictive value of N-BNP for occlusive vascular events and the effects of statins in people with high N-BNP levels are uncertain.. 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 (<386; 386 to 1,171; 1,172 to 2,617; 2,618 to 5,758; and > or =5,759 pg/ml).. Baseline N-BNP was strongly predictive of future vascular events independently of other characteristics. Compared with participants with N-BNP <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 < 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.. 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).

Topics: Adult; Aged; Aged, 80 and over; Cardiovascular Diseases; Chi-Square Distribution; Confidence Intervals; Drug Administration Schedule; Female; Follow-Up Studies; Heart Failure; Humans; Hypercholesterolemia; Linear Models; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Probability; Risk Assessment; Severity of Illness Index; Simvastatin; Stroke; Treatment Outcome

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N-terminal pro B-type natriuretic peptide (NT-proBNP), a cardiac disease biomarker, has been demonstrated to be a strong independent predictor of cardiovascular events in patients without heart failure. Patients with peripheral arterial disease (PAD) are at high risk of cardiovascular events and death. In this study, we investigated levels of NT-proBNP in patients with PAD compared to non-PAD controls. A total of 355 patients were recruited from outpatient clinics at a tertiary care hospital network. Plasma NT-proBNP levels were quantified using protein multiplex. There were 279 patients with both clinical and diagnostic features of PAD and 76 control patients without PAD (non-PAD cohort). Compared with non-PAD patients, median (IQR) NT-proBNP levels in PAD patients were significantly higher (225 ng/L (120-363) vs 285 ng/L (188-425), p- value = 0.001, respectively). Regression analysis demonstrated that NT-proBNP remained significantly higher in patients with PAD relative to non-PAD despite adjusting for age, sex, hypercholesterolemia, smoking and hypertension [odds ratio = 1.28 (1.07-1.54), p-value <0.05]. Subgroup analysis showed elevated NT-proBNP levels in patients with PAD regardless of prior history of CHF, CAD, diabetes and hypercholesteremia (p-value <0.05). Finally, spearmen's correlation analysis demonstrated a negative correlation between NT-proBNP and ABI (ρ = -0.242; p-value < 0.001). In conclusion, our data shows that patients with PAD in an ambulatory care setting have elevated levels of NT-proBNP compared to non-PAD patients in the absence of cardiac symptoms.

Topics: Aged; Comorbidity; Diabetes Mellitus; Female; Heart Diseases; Humans; Hypercholesterolemia; Hypertension; Male; Middle Aged; Natriuretic Peptide, Brain; Outpatient Clinics, Hospital; Outpatients; Peptide Fragments; Peripheral Arterial Disease; Smoking

Cardiac allograft vasculopathy (CAV) still remains to be one of the most important limiting factors for heart transplant recipients' long-term survival. The aim of our study was to identify the perioperative risk factors impacting the occurrence of CAV during the long-term follow-up.. We retrospectively analysed the data from 198 consecutive adult patients, who underwent heart transplantation between 2007 and 2012, in whom at least one routine coronarography (CAG) was performed. CAV onset was defined as any lesion seen at least at one routine CAG.. The average follow-up was 63.6 ± 14.7 months. The frequency of CAV in the analysed population was 36 (18.1%). Multivariate stepwise logistic regression analysis confirmed that NT-proBNP plasma concentration directly before heart transplant [logNT-proBNP OR = 16.455 (4.587-31.036), P < .0001], fibrinogen plasma concentration a month after heart transplant [OR = 1.022 (1.009-1.035), P < .001] and occurrence of diabetes [OR = 12.355 (1.417-35.750), P < .001], were independent predictors of CAV. Area under the ROC curves (AUC) indicated a well discriminatory power of plasma fibrinogen [AUC 0.9278, P < .001] and plasma NTproBNP concentration [AUC 0.9514, P < .001] in CAV prediction. The optimal cut-off value of fibrinogen was 509 mg/dL, and of NT-proBNP was 10080 pg/mL.. Our data show that NT-proBNP and fibrinogen plasma concentrations as well as occurence of diabetes, both preexisting and new onset after heart transplant can be used to identify patients at risk of developing CAV.

Topics: Allografts; Diabetic Angiopathies; Female; Follow-Up Studies; Graft Rejection; Heart Diseases; Heart Transplantation; Humans; Hypercholesterolemia; Hypertension; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Retrospective Studies; Risk Factors; Time Factors; Transplantation, Homologous; Treatment Outcome

To test whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) was independently associated with, and improved the prediction of, cardiovascular disease (CVD) in a primary prevention cohort.. In the West of Scotland Coronary Prevention Study (WOSCOPS), a cohort of middle-aged men with hypercholesterolaemia at a moderate risk of CVD, we related the baseline NT-proBNP (geometric mean 28 pg/mL) in 4801 men to the risk of CVD over 15 years during which 1690 experienced CVD events. Taking into account the competing risk of non-CVD death, NT-proBNP was associated with an increased risk of all CVD [HR: 1.17 (95% CI: 1.11-1.23) per standard deviation increase in log NT-proBNP] after adjustment for classical and clinical cardiovascular risk factors plus C-reactive protein. N-terminal pro-B-type natriuretic peptide was more strongly related to the risk of fatal [HR: 1.34 (95% CI: 1.19-1.52)] than non-fatal CVD [HR: 1.17 (95% CI: 1.10-1.24)] (P= 0.022). The addition of NT-proBNP to traditional risk factors improved the C-index (+0.013; P < 0.001). The continuous net reclassification index improved with the addition of NT-proBNP by 19.8% (95% CI: 13.6-25.9%) compared with 9.8% (95% CI: 4.2-15.6%) with the addition of C-reactive protein. N-terminal pro-B-type natriuretic peptide correctly reclassified 14.7% of events, whereas C-reactive protein correctly reclassified 3.4% of events. Results were similar in the 4128 men without evidence of angina, nitrate prescription, minor ECG abnormalities, or prior cerebrovascular disease.. N-terminal pro-B-type natriuretic peptide predicts CVD events in men without clinical evidence of CHD, angina, or history of stroke, and appears related more strongly to the risk for fatal events. N-terminal pro-B-type natriuretic peptide also provides moderate risk discrimination, in excess of that provided by the measurement of C-reactive protein. Clinical trial registration WOSCOPS was carried out and completed prior to the requirement for clinical trial registration.

Topics: Biomarkers; C-Reactive Protein; Cardiovascular Diseases; Electrocardiography; Follow-Up Studies; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypercholesterolemia; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Pravastatin; Randomized Controlled Trials as Topic; Risk Factors; Scotland

The natriuretic peptides, Brain Natriuretic Peptide (BNP), C-type Natriuretic Peptide (CNP), are mediators of cardiovascular homeostasis. The impairment of arterial ability to vasodilate, also known as endothelial dysfunction, represents the first stage of atherosclerotic damage and may be assessed as brachial flow mediated vasodilation (FMV) in human. Generally an altered brachial FMV is documented in association to several cardiovascular risk factors as hypercholesterolemia. Aim of the study was to evaluate the behaviour of BNP and CNP in hyperlipemia and the potential relationship to FMV.. Forty-four hyperlipemic patients (LDL-cholesterol > 130 mg/dl and/or triglycerides > 150, age 35-60 y) of both genders and 20 normolipemic patients, matched for age and sex were investigated.. Patients had lower values of brachial FMV in comparison to controls (3.9 +/- 3.5 vs 7.5 +/- 0.5%, p < 0.005), no differences were observed in BNP (4.6 +/- 4.6 vs 5.9 +/- 3.4 ng/mL, p = n.s) and CNP (4.1 +/- 5.8 vs 5.7 +/- 3.3 ng/mL, p = n.s). Univariate analysis showed a positive correlation between BNP and HDL-cholesterol values (r = 0.36, p = 0.001). In the multivariate analysis, LDL-cholesterol (beta = -0.57), HDL-cholesterol (beta = 0.26) and brachial artery diameter (beta = -0.33) were predictors of brachial FMV. The only predictive variable for CNP was HDL-cholesterol (beta = 0.37).. The present study suggested that natriuretic peptides, BNP and CNP, are not altered in patients affected by hypercholesterolemia. Nevertheless, the levels of HDL-cholesterol are strictly related to the values of CNP. This observation, in humans, adds another mechanism to the vascular control exerted by HDL.

Topics: Adult; Atherosclerosis; Blood Flow Velocity; Brachial Artery; Cholesterol, HDL; Cholesterol, LDL; Endothelium, Vascular; Female; Humans; Hypercholesterolemia; Male; Middle Aged; Natriuretic Peptide, Brain; Natriuretic Peptide, C-Type; Risk Factors; Statistics as Topic; Triglycerides; Vasodilation

N-terminal pro-brain natriuretic peptide (NT-proBNP) is a useful predictor of cardiovascular events in patients without clinical evidence of cardiovascular disease. It is unknown if the cardiovascular risk factors control can modify these levels. We studied if atorvastatin treatment decrease NT-proBNP levels in hypercholesterolemic subjects, with and without hypertension.. It was an open, prospective study in 39 patients with hypercholesterolemia without clinical evidence of cardiovascular disease. 15 (38.5%) had hypertension. Blood samples were collected initially and 12 and 24 weeks after beginning treatment with 20 mg of atorvastatin.. The median age was 54 years, and 41% were males. NT-proBNP (pg/ml) values were: 193 (294) at baseline; 141 (211) (p < 0.05) after 12 weeks therapy, and 89 (130) (p < 0.01) at 24 weeks. In hypertensive patients value changed from: 275 (388) at baseline, 196 (290) (p < 0.05) and 112 (124) (p < 0.001) after 12 and 24 weeks treatment. And the levels in normotensives patients were: 137 (198) at baseline, 103 (129) (p = NS), and 74 (135) (p < 0.001) at 12 and 24 weeks after treatment with atorvastatin. We didn't find any correlations between the percentage decrease in NT-proBNP levels, and change of total cholesterol, systolic blood pressure, C reactive protein, or nitrites/nitrates blood levels, at 12, and 24 weeks compared to baseline levels.. In middle-aged hypercholesterolemic patients, without evidence of cardiovascular disease, atorvastatin therapy decrease NT-proBNP blood levels, in both hypertensive and normotensives subjects.

Topics: Adult; Aged; Anticholesteremic Agents; Atorvastatin; Female; Heptanoic Acids; Humans; Hypercholesterolemia; Hypertension; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Pyrroles