Natriuretic peptide (NP)-guided treatment may lower ventricular dysfunction and hospitalization in patients with cardiovascular (CV) risk factors but without heart failure, according to a review article published in Cochrane Database of Systematic Reviews.

NPs are well-established biomarkers for heart failure, and measurement of their levels may identify patients at highest risk for CV disease, and guide intensive risk reduction measures and treatment options.

Review authors examined the data from 2 randomized controlled trials (n=1674; mean age, 64.1-67.8 years; follow up, 2-4.3 years). Patients with symptoms of heart failure were excluded. Elevated levels of NP were defined as B-type NP>35 pg/mL or N-terminal pro B-type NP>125 pg/mL, measured using any assay. Secondary outcomes included all-cause hospitalization, all-cause mortality, and ventricular dysfunction.

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In the pooled analysis, NP-guided treatment was found to reduce the risk for CV hospitalization compared with standard care (risk ratio [RR], 0.52; 95% CI, 0.40-0.68). 

NP-guided treatment was found to reduce the risk for all-cause hospitalization (RR, 0.83; 95% CI, 0.75-0.92) and ventricular dysfunction (RR, 0.61; 95% CI, 0.41-0.91). Furthermore, NP-guided treatment was not found to affect the levels of NP at the end of the follow up.

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Study limitations include the fact that the trials examined were pragmatic studies, with a lack of blinding of patients and practices, which may have biased results. “NP-guided treatment is likely to reduce ventricular dysfunction and [CV] and all-cause [hospitalization] for patients who have [CV] risk factors and who do not have heart failure. Effects on mortality and natriuretic peptide levels are less certain. Neither of the included studies were powered to evaluate mortality.…Further studies with more adequately powered sample sizes and longer duration of follow up are required to evaluate the effect of NP-guided treatment on mortality.”


Sweeney C, Ryan F, Ledwidge M, et al. Natriuretic peptide-guided treatment for the prevention of cardiovascular events in patients without heart failure [published online October 15, 2019]. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD013015.pub2