N-Terminal Pro-B-Type Natriuretic Peptide Is a Major Predictor of the Development of Atrial Fibrillation The Cardiovascular Study

Background —Atrial fibrillation (AF), the most common cardiac rhythm abnormality, is associated with significant morbidity, mortality, and healthcare expenditures. Elevated B-type natriuretic peptide levels have been associated with the risk of heart failure, AF, and mortality. Methods and Results —The relation between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and AF was studied in 5445 Cardiovascular Health Study participants with the use of relative risk regression for predicting prevalent AF and Cox proportional hazards for predicting incident AF. NT-proBNP levels were strongly associated with prevalent AF, with an unadjusted prevalence ratio of 128 for the highest quintile (95% confidence interval, 17.9 to 913.3; P (cid:1) 0.001) and adjusted prevalence ratio of 147 for the highest quintile (95% confidence interval, 20.4 to 1064.3; P (cid:1) 0.001) compared with the lowest. After a median follow-up of 10 years (maximum of 16 years), there were 1126 cases of incident AF (a rate of 2.2 per 100 person-years). NT-proBNP was highly predictive of incident AF, with an unadjusted hazard ratio of 5.2 (95% confidence interval, 4.3 to 6.4; P (cid:1) 0.001) for the development of AF for the highest quintile compared with the lowest; for the same contrast, NT-proBNP remained the strongest predictor of incident AF after adjustment for an extensive number of covariates, including age, sex, medication use, blood pressure, echocardiographic parameters, diabetes mellitus, and heart failure, with an adjusted hazard ratio of 4.0 (95% confidence interval, 3.2 to 5.0; P (cid:1) age, race, baseline heart failure, hypertension, overweight or obesity (body mass index (cid:4) 25), and sex. In supplementary analyses, the echocardiographic variables left atrial size, left ventricular dimension, ventricular septal thickness, posterior wall thickness, aortic root dimension, percent fractional shortening, left ventricular mass, ratio of early to late atrial mitral Doppler peak flow velocity, and end-systolic stress were examined. For NT-proBNP measures at examinations other than the baseline examination, the covariate values were taken from the same exam- ination if the variable was measured at that examination or from the nearest examination in time before the NT-proBNP determination if not available at that examination. We report prevalence ratios and hazard ratios from the relative risk regressions and Cox models, respectively, along with 95% confidence intervals (CIs) and P values. All analyses were conducted with STATA 10.0. blood pressure, history of stroke, history of coronary heart disease, and history of congestive heart failure.