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N-terminal pro-B-type natriuretic peptide as a predictor of incident atrial fibrillation in the Multi-Ethnic Study of Atherosclerosis: the effects of age, sex and ethnicity
  1. Kristen K Patton1,
  2. Susan R Heckbert2,
  3. Alvaro Alonso3,
  4. Hossein Bahrami4,
  5. Joao A C Lima5,
  6. Gregory Burke6,
  7. Richard A Kronmal7
  1. 1Division of Cardiology, University of Washington, Seattle, Washington, USA
  2. 2Department of Epidemiology, University of Washington, Seattle, Washington, USA
  3. 3Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
  4. 4Cardiology Division, Stanford University, Stanford, California, USA
  5. 5Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
  6. 6Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  7. 7Department of Biostatistics, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Richard A Kronmal, Collaborative Health Studies Coordinating Center, University of Washington, Bldg. 29, Suite 310, 6200 NE 74th Street, Seattle, WA 98115, USA; kronmal{at}


Objective Atrial fibrillation (AF) is a common source of medical costs, morbidity and mortality. NT pro-brain natriuretic peptide (BNP) is a remarkably strong predictor of AF in older whites; we aimed to assess if this biomarker was as predictive in other racial groups.

Design We used covariate-adjusted Cox model regressions to estimate the HRs of developing AF as a function of NT proBNP, and tested for interactions of NT proBNP with age, gender and race/ethnicity.

Setting The Multi-Ethnic Study of Atherosclerosis (MESA).

Patients 5518 subjects were followed over a median of 7.6 years. During this time, 267 developed AF.

Results NT proBNP was statistically significantly associated with incident AF; for ln NT proBNP, the adjusted HR was 2.2 (95% CI 1.9 to 2.5). Assessed by quintiles, the relationship between NT proBNP was strong and graded; the unadjusted HR for the highest quintile of NT proBNP was 23.7 (95% CI 11.1 to 50.6) and adjusted was 11.4 (95% CI 5.1 to 25.3). NT proBNP was an excellent predictor of incident AF in the younger and older age groups, in men and women and in the different race/ethnicity groups: the HR for ln NT proBNP as a predictor of incident AF ranged from 2.0 to 3.9 in each subgroup.

Conclusions NT proBNP is a robust predictor of incident AF; its prognostic value is more significant in younger patients and women compared with older patients and men. NT proBNP was also as strongly predictive in black patients, Hispanics and Asian/Chinese as in white patients despite a lower incidence of arrhythmia.

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