Atrial natriuretic peptide and the development of congestive heart failurein the oldest old: A seven-year prospective study

BACKGROUND: Atrial natriuretic peptide (ANP) levels are elevated in symptom atic heart failure and correlate with invasively measured left heart pressu res. OBJECTIVE: To examine the association between plasma ANT level and the subs equent development of congestive heart failure (CHF) in older subjects with no history of CHF. DESIGN: A 7-year, prospective, blinded, cohort study. SETTING: A life care facility in Boston, Massachusetts. PARTICIPANTS: Two hundred fifty-six frail older subjects (mean age 88 +/- 7 ) with no history of CHF at study entry. MAIN OUTCOME MEASURE: Clinical episodes of CHF with confirmatory chest roen tgenogram findings. Cox proportional hazard analyses were performed to exam ine the relationship between ANP levels and the development of CHF while co ntrolling for 19 clinical, physical, and laboratory parameters. A Kaplan-Me ier estimator (log-rank test) was used to determine if the development of C HF differed by tertile of ANP. RESULTS: During the follow-up period, 32% of the cohort developed CHF. The mean ANP level in the CHF group was 95 pmol/L +/- 11 pmol/L versus 60 pmol/ L +/- 5 pmol/L in the no CHF group (two tailed t test P = .005). On multiva riate analysis, a high ANP level was found to be associated significantly ( P = .01) with the development of CHF. CONCLUSIONS: There is a statistically significant association between ANP l evel and the subsequent development of CHF in frail older individuals with no history of CHF.