Elevated BNP in HIV Associated With Adverse CV Events, Mortality

Increased levels of B-type natriuretic peptide (BNP) are independently associated with cardiovascular events and mortality in people with HIV, according to a study published in the International Journal of Cardiology.

In this prospective, ongoing, multicenter trial (ClinicalTrials.gov identifier: NCT01119729), researchers followed 808 people with HIV in the German Ruhr region to assess whether BNP levels can predict cardiovascular events and mortality. BNP levels were stratified into 5 groups as follows: ≤5 pg/mL, >5 to ≤20 pg/mL, >20 to ≤35 pg/mL, >35 to ≤100 pg/mL, and >100 pg/mL. Cardiovascular events, including fatal and nonfatal events, were considered as the composite primary end point.

Of the 808 participants, most were men (83.2%) and were white (89%), with an average age of 43.8 ± 10.3 years. At baseline, the median BNP level was 10.3 (interquartile range [IQR] 5.4-18.9).

During a median follow up of 120 months (IQR 113-129), a cardiovascular event occurred in 158 participants, with higher frequencies in those with increased BNP levels: 22% for BNP ≤5 pg/mL, 30% for BNP >5 to ≤20 pg/mL, 38% for BNP >20 to ≤35 pg/mL, 59% for BNP >35 to ≤100 pg/mL, and 86% for BNP >100 pg/mL. Researchers noted that 46 patients died as a result of a cardiovascular event or sudden death.

Doubling of the BNP value was associated with cardiovascular events and mortality (hazard ratio [HR] 1.14; 95% CI, 1.00-1.29; P =.05). Results demonstrated that a BNP >100 pg/mL was significantly associated with increased risk for adverse cardiovascular events and mortality.

In the fully adjusted model that included traditional cardiovascular risks as well as HIV-specific factors, doubling of the BNP value was still significantly associated with increased risk for the composite end point (HR 1.16; 95% CI, 1.01-1.33; P =.031). Comparing BNP of <5 pg/mL with BNP >100 pg/mL, the HR was 3.25 (95% CI, 1.50-7.08; P <.001).

This study included measurement of BNP only, and did not include N-terminal pro BNP. Nevertheless, the findings suggested that BNP levels may be an appropriate biomarker to improve the prediction of cardiovascular events and mortality in people with HIV, independent of traditional cardiovascular risk factors and HIV-specific parameters.

“Further research is warranted to establish age- and gender-adjusted distribution as well as thresholds to define increased BNP levels,” concluded the researchers.

Disclosure: ViiV Healthcare, Gilead, MSD, and Janssen in part supported this study.

Reference

Reinsch N, Streeck H, Holzendorf V, et al; HIV HEART Study Group. B-type natriuretic peptides for the prediction of cardiovascular events and mortality in patients living with HIV: Results from the HIV-HEART study. Int J Cardiol. 2019;281:127-132.