The value of N-terminal fragment of brain natriuretic peptide and tissue inhibitor of metalloproteinase-1 levels as predictors of cardiovascular outcome in the LIPID study.

Description

West et al. reported a nested case control study of 250 pairs of randomly matched subjects enrolled in the long-term intervention with pravastatin in ischemic disease (LIPID) and LIPID extended follow-up studies. Cases were defined as those who had a cardiovascular death, non-fatal myocardial infarction, or stroke during the follow-up, whereas controls were those who remained event-free for an average follow-up period of 2.5 years. This report examined the association between two major biomarkers, the inactive N-terminal fragment of brain natriuretic peptide (NT-proBNP) and tissue inhibitor of metalloproteinase-1 (TIMP-1), and long-term cardiovascular outcomes. The authors found that NT-proBNP and TIMP-1 levels were significantly higher among cases compared to controls [(NT-proBNP: 389 vs. 198 pg/ml, p<0.001) (TIMP: 806 vs.736 pg/ml, p<0.001)]. Moreover, both NT-proBNP and TIMP-1 raised the risk of future cardiovascular events by about two to three-fold even after adjusting for conventional risk factors, statin treatment, and established biomarkers (C-reactive protein, interleukin-6 and white blood cell). These results suggest that in subjects with stable ischemic disease, NT-proBNP and TIMP-1 are both independent predictive markers of coronary heart disease outcome. This article was accompanied by an editorial by MacFadyen who stressed the importance of extending these research findings to the management of individual patients. The author stated that it is time for these biomarkers to be used in clinical practice.