Clinical investigationsNatriuretic peptide plasma concentrations and risk of cardiovascular versus non-cardiovascular events in heart failure with reduced ejection fraction: Insights from the PARADIGM-HF and ATMOSPHERE trials
Section snippets
Study design
We conducted a post hoc analysis of the prospective comparison of angiotensin receptor–neprilysin inhibitor (ARNI) with angiotensin-converting–enzyme inhibitor (ACEI) (PARADIGM HF) trial and the aliskiren trial to minimize outcomes in patients with heart failure (ATMOSPHERE) trial. These trials were approved by ethics committees at all 1,043 participating centers in 47 countries in the PARADIGM-HF trial and 789 centers in 43 countries in the ATMOSPHERE trial. All patients provided written
Baseline characteristics
Of the 15,415 patients randomized cumulatively in the two trials, 14,737 patients (96%) had a measured value of NT-pro-BNP plasma concentration at baseline. About a quarter (N = 3,575) of these patients had AF. Median (Q1, Q3) plasma concentrations of NT-proBNP patients with and without AF were 1817 pg/mL (1,095, 3,266) and 1,271 pg/mL (703, 2,569), respectively. Patients with higher NT-proBNP plasma concentrations were older, had lower eGFR and ejection fraction, were less obese, and had worse
Discussion
In this large cohort of ∼15,000 HFrEF patients from two contemporary clinical trials, we found a differential risk for CV vs non-CV events according to baseline NT-proBNP plasma concentrations. The absolute CV event rates per patient-years of follow-up were higher and had greater stepwise increases than non-CV event rates indicating a differential risk of CV events at varying baseline NT-proBNP plasma concentrations. The results remained similar when patients were stratified according to the
Disclosures:
MV has received research grant support or served on advisory boards for American Regent, Amgen, AstraZeneca, Bayer AG, Baxter Healthcare, Boehringer Ingelheim, Cytokinetics, Lexicon Pharmaceuticals and Relypsa, and participates on clinical endpoint committees for studies sponsored by Galmed, Novartis, and the NIH. LK has received a speaker honorarium from Novartis. WTA has done consulting for Abbott and Impulse Dynamics. ASD has received research grant support from Novartis; and has served as a
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