Km. Davis et al., ATRIAL-NATRIURETIC-PEPTIDE LEVELS IN THE ELDERLY - DIFFERENTIATING NORMAL AGING CHANGES FROM DISEASE, The journals of gerontology. Series A, Biological sciences and medical sciences, 51(3), 1996, pp. 95-101
Background. Atrial natriuretic peptide (ANP) levels increase with adva
ncing age and in patients with cardiac dysfunction. Previous studies h
ave failed to differentiate the elevated ANP levels of normal aging fr
om those of cardiac disease. Methods. To differentiate the increased A
NP levels seen in normal aging from that of disease, tasting supine AN
P was measured in healthy young (n=24), healthy old (n=90), and clinic
ally stable bu cardiovascularly diseased old (n=269) residents of a li
fe care facility. ANP levels were correlated with physical exam findin
gs, blood chemistries, measures of physical and cognitive function, an
d medications. Results. ANP levels were almost fourfold higher in the
healthy elderly than in the young (11.4+/-1.1 (SEM) vs 3+/-0.3 pmol/L.
p <.01), and two-and-one half times higher in the cardiovascular-dise
ased elderly than the healthy elderly (29+/-1.9 vs 11.4+/-1.1 pmol L.
p <.01). An ANP value of 21 pmol L has a sensitivity of 83% and specif
icity of 52% in distinguishing those elders classified as healthy from
those classified as having chronic cardiovascular disease. ANP levels
had positive univariate correlation with age (even from 70 to 102 yea
rs) an systolic blood pressure. ANP rose progressively with increasing
numbers of markers of cardiovascular comorbidity. ANP was higher in s
ubjects with jugular venous pressure 10 cm, presence of a third heart
sound, peripheral edema, artificial cardiac pacemaker, atrial arrhythm
ias, and in those taking digoxin diuretics, or nitrates. On multivaria
te analysis independent predictors of ANP levels were in descending or
der, nitrates, age, diuretics, and atrial arrhythmias. Conclusion. The
se data suggest that ANP levels greater than 21 pmol L are associated
with cardiovascular comorbidity in a clinically stable elderly cohort.