PEACE BNP: Omland, T. et al. J Am Coll Cardiol 2007; 50:205–14 Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply. Prognostic.

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PEACE BNP: Omland, T. et al. J Am Coll Cardiol 2007; 50:205–14 Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply. Prognostic Value of B-Type Natriuretic Peptides in Patients With Stable Coronary Artery Disease: The PEACE Trial Torbjørn Omland, MD, PHD, MPH, Marc S. Sabatine, MD, MPH, Kathleen A. Jablonski, PHD,Madeline Murguia Rice, PHD, Judith Hsia, MD, Ragnhild Wergeland, MT,Sverre Landaas, MD, PHD, Jean L. Rouleau, MD, FACC, Michael J. Domanski, MD, FACC, Christian Hall, MD, PHD, Marc A. Pfeffer, MD, PHD, FACC, Eugene Braunwald, MD, FACC, for the PEACE Investigators

PEACE BNP: Omland, T. et al. J Am Coll Cardiol 2007; 50:205–14 Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply. Background & Objectives n Background: The prognostic value of B-type natriuretic peptides (BNPs) in low-risk patients with stable coronary artery disease remains unclear. n Objectives: The purpose of this study was to assess 1) the association between BNP and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and the incidence of specific cardiovascular events in low-risk patients with stable coronary disease, 2) the incremental prognostic information obtained from these two biomarkers compared with traditional risk factors, and 3) their ability to identify patients who may benefit from angiotensin-converting enzyme (ACE) inhibition.

PEACE BNP: Omland, T. et al. J Am Coll Cardiol 2007; 50:205–14 Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply. Methods n Baseline plasma BNP and NT-proBNP concentrations were measured in 3,761 patients with stable coronary artery disease and preserved left ventricular function participating in the PEACE (Prevention of Events With Angiotensin- Converting Enzyme Inhibition) study, a placebo-controlled trial of trandolapril. n Multivariable Cox regression was used to assess the association between natriuretic peptide concentrations and the incidence of cardiovascular mortality, fatal or nonfatal myocardial infarction, heart failure, and stroke.

PEACE BNP: Omland, T. et al. J Am Coll Cardiol 2007; 50:205–14 Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply. MV Adjustment n Treatment assignment n Age n Gender n Body mass index n Ejection fraction <50% n Estimated glomerular filtration rate n Current smoking n Total cholesterol n C-reactive protein n History of: hypertension or measured hypertension, myocardial infarction, diabetes, stroke, percutaneous coronary intervention, coronary artery bypass grafting, n Use of: a beta-blocker, lipid-lowering drug, aspirin or an antiplatelet medication, or diuretic. Outcomes were adjusted for:

PEACE BNP: Omland, T. et al. J Am Coll Cardiol 2007; 50:205–14 Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply. Association Between BNPs as Continuous Variables and CV Outcomes Outcome BNPNT-proBNP HR (95% CI) * p ValueHR (95% CI) * p Value Cardiovascular mortality 1.28 (1.08–1.51) (1.69–2.36)<0.001 Fatal/nonfatal MI0.95 (0.83–1.08) (0.93–1.18)0.43 Fatal/nonfatal CHF1.92 (1.61–2.27)< (2.33–3.38)<0.001 Fatal/nonfatal stroke1.35 (1.10–1.65) (1.58–2.36)<0.001 * Per 1 SD pg/ml in log BNP and log NT-proBNP, adjusted for randomization status

PEACE BNP: Omland, T. et al. J Am Coll Cardiol 2007; 50:205–14 Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply. NT-ProBNP and CV Death

PEACE BNP: Omland, T. et al. J Am Coll Cardiol 2007; 50:205–14 Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply. NT-ProBNP and Heart Failure

PEACE BNP: Omland, T. et al. J Am Coll Cardiol 2007; 50:205–14 Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply. NT-ProBNP and Stroke

PEACE BNP: Omland, T. et al. J Am Coll Cardiol 2007; 50:205–14 Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply. Multivariable Analysis of Association Between BNPs as Continuous Variables and CV Outcomes Outcome BNP NT-ProBNP HR (95% CI) * p ValueHR (95% CI) * p Value Cardiovascular mortality 1.06 (0.87–1.28) (1.38–2.07)<0.001 Fatal/nonfatal MI0.91 (0.77–1.07) (0.87–1.19)0.84 Fatal/nonfatal CHF1.62 (1.32–1.97)< (1.86–2.98)<0.001 Fatal/nonfatal stroke1.15 (0.91–1.45) (1.26–2.12)<0.001 * Per 1 SD pg/ml in log BNP and NT-proBNP.

PEACE BNP: Omland, T. et al. J Am Coll Cardiol 2007; 50:205–14 Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply. Conclusion In low-risk patients with stable coronary artery disease and preserved ventricular function, BNPs provide strong and incremental prognostic information to traditional risk factors.