Study Finds Major Predictor for Development of New Atrial Fibrillation (AF)
November 16, 2009 5:18 AM CT
By Peggy Noonan
Researchers have found a new “major predictor” of the development of new cases of atrial fibrillation (AF). The key is N-terminal pro-B-type natriuretic peptide (NT-proBNP).
Previous studies have shown that levels of a related hormone, B-type natriuretic peptide (BNP), can predict atrial fibrillation and even death. BNP is a protein hormone that is mainly produced in the heart’s lower left chamber, the left ventricle. It helps regulate blood volume and thus helps control how hard the heart works when it pumps blood. It can be a response to stretching of the heart muscle cells. When the heart has to work harder, the levels of BNP and NT-proBNP in the blood increase.
NT-proBNP is an inactive fragment that is produced alongside BNP, but which stays in the bloodstream longer. This new study, the Cardiovascular Health Study, looked at NT-proBNP as a potential predictor of afib.
In this new study, which was published in the journal Circulation, 5,445 people over the age of 65 were tracked for 10–16 years. Over that time, there were 1,126 new atrial fibrillation cases (20%). NT-proBNP was found to be the strongest predictor of new afib. Those with the highest levels were four times as likely to develop atrial fibrillation as those with the lowest levels.
Thus, NT-proBNP was “highly predictive” of new (incident) afib, regardless of other risk factors, such as age, gender, blood pressure, diabetes, or heart failure. Surprisingly, elevated levels of NT-proBNP occurred as much as 16 years before the onset of atrial fibrillation.
Comment: Since NT-proBNP is such a strong predictor of future atrial fibrillation, what does this mean for those concerned about afib, especially if other family members already have it?
Tests for BNP and NT-proBNP are used today to screen for heart failure, so the tests are already there, but use in screening for atrial fibrillation is not currently an established practice. However, with this newest research and related research that is briefly discussed below, this may one day be a routine method of screening for future afib.
To learn more about this study, see:
- N-Terminal Pro-B-Type Natriuretic Peptide Is a Major Predictor of the Development of Atrial Fibrillation, Circulation
- NT-proBNP “remarkable predictor” of incident atrial fibrillation, TheHeart.org
And in related research:
- A high blood level of BNP or NT-proBNP before surgery “is a powerful, independent predictor of cardiovascular events” in the first month after non-cardiac (non-heart) surgery.See: Is a Pre-Operative Brain Natriuretic Peptide or N-Terminal Pro–B-Type Natriuretic Peptide Measurement an Independent Predictor of Adverse Cardiovascular Outcomes Within 30 Days of Noncardiac Surgery?, Journal of the American College of Cardiology
- High blood levels of BNP should be a “strong predictor” of delayed afib after ischemic stroke or transient ischemic attack (TIA), researchers from Japan report.See: Brain natriuretic peptide as a predictor of delayed atrial fibrillation after ischaemic stroke and transient ischaemic attack, European Journal of Neurology
For more information about BNP and NT-proBNP as well as tests to determine blood levels of them, see:
Peggy Noonan specializes in writing about health for consumers and medical professionals. She writes for leading national magazines and consumer publications as well as StopAfib.org.