Kenyu Sato

Cardiovascular Risk Stratification With Plasma B-Type Natriuretic Peptide Levels in a Community-Based Hypertensive Cohort

Few reports have examined the utility of plasma B-type natriuretic peptide (BNP) testing for cardiovascular (CV) risk stratification in real-world hypertensive subjects. Subjects of the study were community-based hypertensive patients (n = 5,865). The CV event rate within each BNP quartile was estimated, and a Cox regression model was used to determine the relative hazard ratio (HR) among the quartiles. Furthermore, to determine the usefulness of BNP as a biomarker in combination with the Framingham risk score (FRS), the predictive abilities in terms of area under the curve of receiver operating characteristic analysis, net reclassification improvement, and integrated discrimination improvement indices were determined. The mean follow-up duration was 5.6 years. The highest quartile showed a significantly higher rate of CV events compared with the lower quartiles (p <0.001). After adjustment for established CV risk factors, the HR for CV events increased significantly according to the quartile (p value for trend <0.03), and the HR for the highest quartile was significantly elevated compared with the lowest quartile (HR 1.59, 95% confidence interval 1.16 to 2.19). The predictive abilities of BNP in terms of sensitivity and specificity for CV events were comparable with those of FRS. When BNP was added to an FRS-only model, the predictive abilities in terms of area under receiver operating characteristic curve, net reclassification improvement, and integrated discrimination improvement were significantly increased (all; p <0.001). Elevated BNP levels are thus a useful biomarker for CV risk stratification in unselected real-world hypertensive subjects. Adding BNP to an established CV risk score improves the predictive ability in this cohort.

Sex-specific temporal trends in the incidence and prevalence of hospitalized patients with preserved versus reduced left ventricular ejection fraction heart failure: A Japanese community-wide study

Background Sex specific temporal trends in the incidence and prevalence of hospitalization for heart failure (HF), particularly in conjunction with reduced and preserved left ventricular ejection fraction (EF) remain unclear, especially in Asian general populations. Methods We conducted a community based HF registration study over a 10 year period in an aging cohort of the Japanese general population. Results A total of 2598 cases of hospitalized HF were registered during the survey period. Of these 1413 cases (55%) were initial admissions for HF (incident case). The study period was divided into five 2-year terms (T1, 2003–2004; T2, 2005–2006; T3, 2007–2008; T4, 2009–2010; T5, 2011–2012), and data were compared among the terms. Age adjusted incidence of HF (per 105 person-year) remained stable in men, but decreased significantly by 25% in women (from 104 at T1 to 79 at T5; p for trend < 0.05). Among incident cases who underwent echocardiography (≈ 90%), the proportion of HF with preserved EF increased in men (from 32% at T1 to 43% at T5; p for trend < 0.05), and was relatively high and remained stable throughout the study period in women (from 52% at T1 to 58% at T5; p for trend; NS). Conclusion Although the incidence of HF has declined especially in women between 2003 and 2012 in the study population, the proportion of HF with preserved EF has increased over time. These trends suggest a future prevalence of HF with preserved EF rather than HF with reduced EF in aging Asian populations.