Copyright © 1999 by the European Society of Cardiology.
Circulating N-terminal pro-atrial natriuretic peptide is an independent predictor of left ventricular hypertrophy in the general population
The Tromsø Study
a Institute of Community Medicine, University of Tromsø Tromsø Norway
b Department of Medicine, Ullevål University Hospital, Oslo, Norway
Received September 29, 1998; accepted October 28, 1998
Abstract
Purpose The purpose of this study was to determine whether circulating N-terminal pro-atrial natriuretic peptide (N-ANP) levels predict left ventricular hypertrophy in the general population after adjustment for relevant risk factors.
Method and Results In a population-based sample of 3287 subjects aged 25–85 years, circulating N-ANP was measured in a subgroup of 389 subjects. Left ventricular mass and ejection fraction were determined by two-dimensional guided M-mode echocardiography. Left ventricular hypertrophy was defined as height adjusted mass above 145·5g.m–1and 125·4g.m–1, in men and women, respectively. Fifty-one subjects with left ventricular hypertrophy had significantly higher N-ANP levels than controls (1075 vs 763pmol.l–1;P<0·0001). A gradually increasing prevalence of left ventricular hypertrophy over increasing 500pmol.l–1intervals of N-ANP was observed (1·8 to 64·3%; (Chi-squaredPfor trend <0·001). N-ANP was an independent predictor of left ventricular hypertrophy after adjustment for ejection fraction, body mass index, hypertension, valvular disease, a history of myocardial infarction, gender, and age. The adjusted odds ratio for left ventricular hypertrophy was 1·79 (95% CI 1·04–3·07) for a 500pmol.l–1increase in N-ANP. A substantial proportion of subjects with elevated N-ANP levels had combined left ventricular hypertrophy and left ventricular dysfunction.
Conclusion These results suggests that N-ANP is an independent predictor of left ventricular hypertrophy in the general population. N-ANP determination is, however, poorly suited to distinguish between subjects with isolated left ventricular hypertrophy and left ventricular dysfunction with or without left ventricular hypertrophy.
Key Words: Natriuretic peptides • echocardiography • hypertrophy • heart failure • population
f1 Correspondence: Henrik Schirmer, MD, Institute of Community Medicine, University of Tromsø, N-9037 Tromsø, Norway.
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