Incidence of Atrial Fibrillation in Persons with Very High Serum Levels of N-Terminal Pro-B-Type Natriuretic Peptide: The Multi-Ethnic Study of Atherosclerosis

Abstract

Objective

While persons in the upper fourth or fifth of the distribution of serum levels of N-terminal pro-B type natriuretic peptide (NT-proBNP) are at a sharply increased risk of developing atrial fibrillation, their absolute risk of this condition (about 20 per 1000 per year) is not clearly high enough to justify prevention or early detection measures. We sought to determine whether the incidence of atrial fibrillation among persons with VERY high levels of NT-proBNP might be sufficiently high to warrant further action.

Design and Setting

Among persons enrolled in the Multi-Ethnic Study of Atherosclerosis, we documented rates of new onset atrial fibrillation in those with increasingly high serum levels of NT-proBNP.

Results

There was a monotonic increase in the incidence of atrial fibrillation with increasing serum level of NT-proBNP, reaching rates of about 50–70 cases per 1000 person-years among those in the upper 3.1% of the distribution (above 422 pg/mL). In this group the incidence tended to be somewhat higher still among persons who were at increased risk of atrial fibrillation for other reasons (eg older age), but in no subgroup did the incidence reach 100 per 1000 person-years.

Conclusion

Serum levels of NT-proBNP have a considerable ability to predict the development of atrial fibrillation. However, the value of screening middle aged and older adults for these levels hinges largely on the ability of interventions in screen-positive people to lead to a reduced incidence of atrial fibrillation and its complications.

Keywords:

• atrial fibrillation
• NT-proBNP

MESA IRB Names and Numbers

Wake Forest University IRB number IRB00008492 under Federal-wide Assurance – FWA00001435

Columbia University IRB number IRB00002973 under Federal-wide Assurance – FWA00002636

Johns Hopkins University IRB number 00001656 under Federal-wide Assurance – FWA00005752

University of Minnesota IRB number IRB00000438 under Federal-wide Assurance – FWA00000312

Northwestern University IRB number IRB00005003 under Federal-wide Assurance – FWA00001549

University of California Los Angeles IRB number 00000172 under Federal-wide Assurance – FWA00004642

University of Washington IRB number IRB00005647 under Federal-wide Assurance – FWA00006878.

Ethics Statement

The MESA study was approved by the Institutional Review Boards at the participating institutions, and written informed consent was given by all participants. The study was conducted in accordance with the Declaration of Helsinki.

Disclosure

Dr Susan R Heckbert reports grants from NIH, during the conduct of the study. The authors report no other conflicts of interest in this work.

Additional information

Funding

This research was supported by contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 and grant R01-HL127659 from the National Heart, Lung, and Blood Institute, and by grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 from the National Center for Advancing Translational Sciences (NCATS). The authors thank the other investigators, the staff, and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org.