Association Between Changes in Serum N-Terminal Pro B-Type Natriuretic Peptide Levels and All-Cause and Cause-Specific Mortality　- The Hisayama Study.

BACKGROUND: Few epidemiological studies have investigated the association between changes in serum N-terminal pro B-type natriuretic peptide (NT-proBNP) and mortality in the general Asian population. METHODS AND RESULTS: We followed 2,703 community-dwelling Japanese residents aged ≥40 years who had serum NT-proBNP concentrations measured in both 2002-2003 and 2007-2008 over a median period of 10.3 years. Changes in NT-proBNP were categorized as decreasing (change ≤-25%), no change (-25%<change<+25%), or increasing (change ≥+25%). Mortality hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models. During the follow-up period, 497 deaths occurred (108 cardiovascular, 389 non-cardiovascular). Compared with the no-change group, multivariable-adjusted HRs in the increasing group were 1.73 (95% CI 1.37-2.17), 1.76 (95% CI 1.08-2.87), and 1.71 (95% CI 1.32-2.22) for all-cause, cardiovascular, and non-cardiovascular mortality, respectively. Subgroup analyses by baseline serum NT-proBNP concentration (2002-2003) showed consistent associations with all-cause mortality in both lower (<125 pg/mL) and higher (≥125 pg/mL) NT-proBNP groups, with a tendency towards stronger associations in the higher NT-proBNP group. CONCLUSIONS: Changes in serum NT-proBNP concentrations may indicate mortality risk in a community-dwelling Asian population.