Plasma concentration of amino-terminal pro-brain natriuretic peptide in chronic heart failure: prediction of cardiovascular events and interaction with the effects of rosuvastatin: a report from CORONA (Controlled Rosuvastatin Multinational Trial in Heart Failure).

Plasma concentration of amino-terminal pro-brain natriuretic peptide in chronic heart failure: prediction of cardiovascular events and interaction with the effects of rosuvastatin: a report from CORONA (Controlled Rosuvastatin Multinational Trial in Heart Failure).

MedLine Citation:	PMID: 19892235 Owner: NLM Status: MEDLINE
Abstract/OtherAbstract:	OBJECTIVES: We investigated whether plasma amino-terminal pro-brain natriuretic peptide (NT-proBNP), a marker of cardiac dysfunction and prognosis measured in CORONA (Controlled Rosuvastatin Multinational Trial in Heart Failure), could be used to identify the severity of heart failure at which statins become ineffective. BACKGROUND: Statins reduce cardiovascular morbidity and mortality in many patients with ischemic heart disease but not, overall, those with heart failure. There must be a transition point at which treatment with a statin becomes futile. METHODS: In CORONA, patients with heart failure, reduced left ventricular ejection fraction, and ischemic heart disease were randomly assigned to 10 mg/day rosuvastatin or placebo. The primary composite outcome was cardiovascular death, nonfatal myocardial infarction, or stroke. RESULTS: Of 5,011 patients enrolled, NT-proBNP was measured in 3,664 (73%). The midtertile included values between 103 pmol/l (868 pg/ml) and 277 pmol/l (2,348 pg/ml). Log NT-proBNP was the strongest predictor (per log unit) of every outcome assessed but was strongest for death from worsening heart failure (hazard ratio [HR]: 1.99; 95% confidence interval [CI]: 1.71 to 2.30), was weaker for sudden death (HR: 1.69; 95% CI: 1.52 to 1.88), and was weakest for atherothrombotic events (HR: 1.24; 95% CI: 1.10 to 1.40). Patients in the lowest tertile of NT-proBNP had the best prognosis and, if assigned to rosuvastatin rather than placebo, had a greater reduction in the primary end point (HR: 0.65; 95% CI: 0.47 to 0.88) than patients in the other tertiles (heterogeneity test, p = 0.0192). This reflected fewer atherothrombotic events and sudden deaths with rosuvastatin. CONCLUSIONS: Patients with heart failure due to ischemic heart disease who have NT-proBNP values <103 pmol/l (868 pg/ml) may benefit from rosuvastatin.

Authors:	John G F Cleland; John J V McMurray; John Kjekshus; Jan H Cornel; Peter Dunselman; C?ndida Fonseca; Ake Hjalmarson; Jerzy Korewicki; Magnus Lindberg; Naresh Ranjith; Dirk J van Veldhuisen; Finn Waagstein; Hans Wedel; John Wikstrand;
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Publication Detail:	Type: Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
Journal Detail:	Title: Journal of the American College of Cardiology Volume: 54 ISSN: 1558-3597 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2009 Nov
Date Detail:	Created Date: 2009-11-06 Completed Date: 2009-12-03 Revised Date: 2010-04-09
Medline Journal Info:	Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States
Other Details:	Languages: eng Pagination: 1850-9 Citation Subset: AIM; IM
Copyright Information:	2009 by the American College of Cardiology Foundation
Affiliation:	Department of Cardiology, University of Hull, Kingston-upon-Hull, United Kingdom. j.g.cleland@hull.ac.uk
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MeSH Terms
Descriptor/Qualifier:	Aged Aged, 80 and over Female Fluorobenzenes / therapeutic use* Heart Failure / blood, diagnosis, drug therapy, mortality Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use Lipoproteins / blood Male Middle Aged Natriuretic Peptide, Brain / blood* Peptide Fragments / blood* Prognosis Pyrimidines / therapeutic use* Sulfonamides / therapeutic use* Triglycerides / blood
Chemical
Reg. No./Substance:	0/Fluorobenzenes; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 0/Lipoproteins; 0/Peptide Fragments; 0/Pyrimidines; 0/Sulfonamides; 0/Triglycerides; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain; 287714-41-4/rosuvastatin
Comments/Corrections
Comment In:	J Am Coll Cardiol. 2010 Apr 13;55(15):1645-6; author reply 1646 [PMID: 20378088 ] J Am Coll Cardiol. 2009 Nov 10;54(20):1860-1 [PMID: 19892236 ] J Am Coll Cardiol. 2010 Apr 13;55(15):1644-5; author reply 1646 [PMID: 20378087 ]

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