Natriuretic Peptide Applications in Cardiovascular Risk Assessment

Natriuretic peptides are cardiac-derived hormones that regulate volume homeostasis and vascular tone. Circulating concentrations of B-type natriuretic peptide (BNP) and its N-terminal fragment (NT-proBNP) rise in response to myocardial wall stress, making them sensitive indicators of subclinical and overt cardiac dysfunction. Beyond their established role in diagnosing heart failure, measurement of these peptides has been incorporated into algorithms for predicting incident cardiovascular events in asymptomatic individuals and for stratifying risk in patients with established disease. Integration of peptide levels with traditional risk factors improves discrimination of future coronary events, stroke and heart failure, and supports early referral for imaging or specialist intervention. Recent advances have also demonstrated that natriuretic peptide assays can guide therapy initiation and monitor treatment response in populations with diabetes, hypertension or coronary artery disease. Collectively, these data underscore the global potential of natriuretic peptides to personalise cardiovascular prevention and to refine primary and secondary risk prediction across diverse clinical settings.

Research from Nature Portfolio

A large-scale individual-participant meta-analysis pooled data for over 25 000 community dwellers to examine baseline NT-proBNP and its association with long-term mortality. Individuals in the top third of NT-proBNP distribution exhibited two- to four-fold higher risks of cardiovascular and all-cause death compared with those in the bottom third. Incorporation of NT-proBNP into conventional risk models yielded modest but consistent increases in the C-index and net reclassification improvement, demonstrating enhanced discrimination of subjects at greatest risk. These findings confirm that even in ostensibly healthy populations, natriuretic peptide assessment can integrate heart failure prediction into broader cardiovascular prevention strategies.

Natriuretic Peptide Applications in Cardiovascular Risk Assessment publication trend

The graph below shows the total number of articles in natriuretic peptide applications in cardiovascular risk assessment across all publications each year (not limited to Nature Index journals).

Technical terms

Natriuretic peptides: A family of cardiac hormones, including atrial NP and B-type NP, released in response to increased myocardial wall stretch.

B-type natriuretic peptide (BNP): The active hormone form cleaved from proBNP that induces natriuresis, vasodilation and inhibition of the renin–angiotensin system.

N-terminal pro-B-type natriuretic peptide (NT-proBNP): The inactive amino-terminal fragment of proBNP, measured in plasma as a stable biomarker of cardiac stress.

C-index: A statistical metric reflecting the concordance between predicted and observed event order; higher values indicate improved model discrimination.

Net reclassification improvement (NRI): A measure of how well the addition of a new marker reassigns individuals into more appropriate risk categories compared to a base model.

References

1. Natriuretic peptides and integrated risk assessment for cardiovascular disease: an individual-participant-data meta-analysis. The Lancet Diabetes & Endocrinology (2016).
2. Detecting heart stress using NT-proBNP in patients with type 2 diabetes mellitus and hypertension or high-normal blood pressure: a cross-sectional multicentric study. Cardiovascular Diabetology (2024).
3. NT-ProBNP and mortality across the spectrum of glucose tolerance in the general US population. Cardiovascular Diabetology (2022).
4. Prognostic value of NT-proBNP in patients with chronic coronary syndrome and normal left ventricular systolic function according to glucose status: a prospective cohort study. Cardiovascular Diabetology (2021).