Pro-B-Type Natriuretic Peptide Strongly Predicts Future Cardiovascular Events in Cardiovascular Disease Patients with NAFLD as Well as in Those without NAFLD

Elevated pro-B type natriuretic peptide (pro-BNP) has been found to be a strong marker of cardiovascular risk in several high-risk populations. However, the power of pro-B type natriuretic peptide (pro-BNP) to predict future cardiovascular events in patients with the combination of established cardiovascular disease and nonalcoholic fatty liver disease (NAFLD) is unclear and is addressed in the present study. We enrolled 794 patients with established cardiovascular disease, 553 with angiographically proven stable CAD and 241 with sonographically proven peripheral artery disease. Prospectively, cardiovascular events were recorded over a mean follow-up period of 8.7±3.3 years. At baseline, pro-BNP was not significantly different in patients with NAFLD (n=394) than in those who did not have NAFLD (796±2208 vs. 798±2520 pg/ml; p=0.234). During follow-up, 376 patients suffered cardiovascular events; the event rate was significantly higher in patients with NAFLD than in subjects without NAFLD (56.6 vs. 43.4%; p<0.001). Pro-BNP predicted cardiovascular events in the total study population, with a standardized adjusted hazard ratio (HR) of1.36 [1.26-1.46]; p<0.001. Further, pro-BNP predicted cardiovascular events in patients with NAFLD (HR 1.45 [1.28-1.65]; p<0.001) as well as in those who did not have NAFLD (HR 1.34 [1.19-1.50]; p<0.001). Interaction terms pro-BNP x NAFLD were non-significant for cardiovascular events (p=0.198), indicating that the power of pro-BNP to predict cardiovascular events did not differ significantly between cardiovascular disease patients with NAFLD and those who did not have NAFLD. We conclude that pro-BNP strongly predicts cardiovascular events in cardiovascular disease patients with NAFLD as well as in those without NAFLD. Disclosure M. Maechler: None. L. Sprenger: None. A. Mader: None. B. Larcher: None. A. Vonbank: None. T. Plattner: None. A. Leiherer: None. A. Muendlein: None. H. Drexel: None. C.H. Saely: None.