B-type natriuretic peptides for the prediction of cardiovascular events and mortality in patients living with HIV: Results from the HIV-HEART study.
AIMS
B-type natriuretic peptide (BNP) has been suggested to improve risk prediction of cardiovascular (CV) events and mortality. We aimed to evaluate the value of BNP to predict the composite primary endpoint of CV events and mortality alongside traditional and HIV specific risk factors in a HIV-infected population.


METHODS
In this prospective multicenter HIV-HEART study we followed 808 HIV-positive subjects in the German Ruhr area for a median follow up of 120 (IQR:113-129) months since 2004. Association of BNP with the composite primary endpoint was assessed using Cox regression adjusting for traditional cardiovascular and HIV specific risk factors.


RESULTS
At baseline, median BNP was 10.3 (IQR 5.4-18.9) pg/ml. The composite endpoint occurred in 158 (19.6%) patients. Subjects with high BNP levels showed significantly increased frequencies of CV events and death (22% for BNP ≤5 pg/ml, 30% for BNP >5 up to ≤20 pg ml, 38% for BNP >20 up to ≤35 pg ml, 59% for BNP >35 up to ≤100 pg ml and 86% for BNP >100 pg/ml, p-value < 0.01). In the fully adjusted model that included traditional CV risks as well as HIV specific factors, after a log2 transformation, doubling of BNP was significantly associated with increased risk for the composite endpoint (HR:1.16 (95%CI 1.01-1.33); p = 0.031). Comparing BNP of <5 pg/ml to BNP > 100 pg/ml, HR in the fully adjusted model was 3.25 (95%CI 1.50-7.08; p < 0.001).


CONCLUSIONS
Increased BNP is associated with significant excess of incident CV events and mortality in HIV-infected patients. BNP is a valuable marker to improve the prediction of CV events and mortality.
['Reinsch|Nico|N|', 'Streeck|Hendrik|H|', 'Holzendorf|Volker|V|', 'Schulze|Christina|C|', 'Neumann|Till|T|', 'Brockmeyer|Norbert H|NH|', 'Kehrmann|Jan|J|', 'Schadendorf|Dirk|D|', 'Esser|Stefan|S|', '|||']
D000328:Adult D000368:Aged D015415:Biomarkers D002318:Cardiovascular Diseases D005260:Female D005500:Follow-Up Studies D015658:HIV Infections D015497:HIV-1 D006801:Humans D008297:Male D008875:Middle Aged D009026:Mortality D020097:Natriuretic Peptide, Brain D011237:Predictive Value of Tests D011446:Prospective Studies
Cardiovascular events HIV BNP Prognosis