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Atrial Natriuretic Peptide and the Development of Congestive Heart Failure in the Oldest Old: A Seven‐Year Prospective Study
Author(s) -
Knight Eric L.,
Fish Loretta C.,
Kiely Dan K.,
Marcantonio Edward R.,
Davis Kenneth M.,
Minaker Kenneth L
Publication year - 1999
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1999.tb07231.x
Subject(s) - medicine , heart failure , prospective cohort study , atrial natriuretic peptide , cardiology , natriuretic peptide , hazard ratio , cohort , proportional hazards model , brain natriuretic peptide , cohort study , confidence interval
BACKGROUND : Atrial natriuretic peptide (ANP) levels are elevated in symptomatic heart failure and correlate with invasively measured left heart pressures. OBJECTIVE : To examine the association between plasma ANP level and the subsequent development of congestive heart failure (CHF) in older subjects with no history of CHF. DESIGN : A 7‐year, prospective, blinded, cohort study. SETTING : A life care facility in Boston, Massachusetts. PARTICIPANTS : Two hundred fifty‐six frail older subjects (mean age 88 ± 7) with no history of CHF at study entry. MAIN OUTCOME MEASURE : Clinical episodes of CHF with confirmatory chest roentgenogram findings. Cox proportional hazard analyses were performed to examine the relationship between ANP levels and the development of CHF while controlling for 19 clinical, physical, and laboratory parameters. A Kaplan‐Meier estimator (log‐rank test) was used to determine if the development of CHF differed by tertile of ANP. RESULTS : During the follow‐up period, 32% of the cohort developed CHF. The mean ANP level in the CHF group was 95 pmol/L ±11 pmol/L versus 60 pmol/L ± 5 pmol/L in the no CHF group (two tailed t test P = .005). On multivariate analysis, a high ANP level was found to be associated significantly ( P =. 01) with the development of CHF. CONCLUSIONS : There is a statistically significant association between ANP level and the subsequent development of CHF in frail older individuals with no history of CHF.;