Comparison of the Capabilities of a Midregional Fragment of the Pro-A-Type Natriuretic Peptide and the N-Terminal Pro-B-Type Natriuretic Peptide for Predicting Mortality and Cardiovascular Events

Study Questions:

What is the comparative prognostic value for a midregional fragment of pro–A-type natriuretic peptide (MR-proANP) and N-terminal pro–B-type natriuretic peptide (NT-proBNP) for predicting mortality and cardiovascular events?


The authors compared the capabilities of NT-proBNP, a marker with known prognostic value for identifying cardiovascular events, when measured in population-based sampling, to a novel immunoassay that measures MR-proANP. A total of 7,819 patients who participated in the population-based prospective observational study, Prevention of Renal and Vascular End-stage Disease (PREVEND), were included. This study included all inhabitants of Groningen, the Netherlands ages 28-75 years, who had an increased urinary albumin, as well as a cohort of randomly selected normal patients. Endpoints included: all-cause mortality, cardiovascular mortality, and cardiovascular events assessed after a median follow-up of 10.5 years.


Increased plasma concentrations of both natriuretic peptides were associated with an increased risk of all-cause mortality and cardiovascular events, after adjustment for age, sex, and other cardiovascular risk factors. The models with MR-proANP and NT-proBNP were comparable in predicting all-cause mortality, cardiovascular mortality, and cardiovascular events. In contrast to NT-proBNP, MR-proANP was not an independent predictor of cardiovascular mortality. In all models, the integrated discrimination improvement was higher for NT-proBNP than for MR-proANP.


The authors concluded that MR-proANP was as efficient as NT-proBNP in predicting all-cause mortality, cardiovascular mortality, and cardiovascular events; however, its association with cardiovascular mortality was not independent from other confounders.


Results from a larger community study on the NT-proANP provide similar prognostic information to NT-proBNP in this study. NT-proBNP was slightly better in regard to cardiovascular mortality, but overall, the similar results in this study as well as previous studies suggest that NT-proANP can be considered prognostically similar to other natriuretic peptides.

Clinical Topics: Prevention, Diet

Keywords: Follow-Up Studies, Kidney Failure, Chronic, Diuretics, Risk Factors, Motor Vehicles, Prognosis, Immunoassay, Biological Markers, Cardiology, Energy Intake, Netherlands, Atrial Natriuretic Factor, Natriuretic Peptide, Brain

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