January 30, 2017Open Access

N-terminal pro-brain natriuretic peptide and cardiovascular or all-cause mortality in the general population: A meta-analysis

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: General population (n=25715). Intervention: Highest category of NT-proBNP concentrations vs. Lowest category of NT-proBNP concentrations. Primary outcome: All-cause mortality (HR 2.44, 95% CI 2.11-2.83).

Key Result

Individuals in the highest category of baseline NT-proBNP concentrations had a significantly increased risk of all-cause mortality (HR 2.44) and cardiovascular mortality (HR 3.77) compared to the lowest category.

Study Design

Type

Meta-Analysis (n=25,715)

PICO

Population

General population (n=25,715)

Intervention / Comparator

Highest category of NT-proBNP concentrations vs Lowest category of NT-proBNP concentrations

Primary Outcome

All-cause mortality — HR 2.44 (2.11-2.83)

Main Result

Effect estimate: HR 2.44 (95% CI 2.11-2.83)

Limitations

Circulating concentrations of NT-proBNP were determined at a single measurement at baseline without observing dynamic changes.
Subgroup analysis findings may be limited by the relatively small number of included studies.
The majority of included studies pertained to older participants, limiting generalization to middle-aged individuals.
Results of publication bias may be unreliable because the number of studies was less than 10.
Unable to define the optimal thresholds for NT-proBNP due to marked variation across studies.

Abstract

The prognostic role of N-terminal pro-brain natriuretic peptide (NT-proBNP) in the general population remains controversial. We conducted this meta-analysis to investigate the association between baseline NT-proBNP concentrations and cardiovascular or all-cause mortality in the general population. PubMed and Embase databases were systematically searched from their inception to August 2016. Prospective observational studies that investigated the association between baseline NT-proBNP concentrations and cardiovascular or all-cause mortality in the general population were eligible. A summary of the hazard ratio (HR) and 95% confidence interval (CI) of mortality were calculated by the highest versus the lowest category of NT-proBNP concentrations. Eleven studies with a total of 25,715 individuals were included. Compared individuals in the highest with those in the lowest category of NT-proBNP, the pooled HR was 2.44 (95% CI 2.11-2.83) for all-cause mortality, 3.77 (95% CI 2.85-5.00) for cardiovascular mortality, and 2.35 (95% CI 1.45-3.82) for coronary heart disease mortality, respectively. Subgroup analyses indicated that the effects of NT-proBNP on the risk of cardiovascular mortality (RR 2.27) and all-cause mortality (RR 3.00) appeared to be slightly lower among men. Elevated NT-proBNP concentrations appeared to be independently associated with increased risk of cardiovascular and all-cause mortality in the general population.

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