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Increased use of NT-proBNP could help curb India’s heart disease toll

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International Consensus Statement calls for routine screening for at-risk patients

The biomarker, NT-proBNP should be widely used in
both primary care, as well as the emergency department, to more accurately diagnose patients with heart failure, claims Dr Antoni Bayes-Genis, a renowned cardiologist from Barcelona, Spain. Indian cardiologists will hear first hand from Dr Bayes-Genis, who is also one of the authors of the International Consensus Statement on the use of NT-proBNP in the management of heart failure – an important issue given India will have the highest number of heart failure patients in the world by 2015.

The international panel of experts, including Dr. Bayes-Genis, Director of Heart Failure and Heart Transplant Unit in Hospital de la Santa Creu i Sant Pau. Barcelona, recently released a set of recommendations on the use of NT-proBNP. These recommendations, which are being discussed in India by Dr. Bayes-Genis, were published in the American Journal of Cardiology. The panel concluded that NT-proBNP holds great promise as a routine screening tool in high risk populations, as well as a useful screening tool in the general population for detection of cardiac abnormalities and the prediction of future cardiovascular events, such as heart failure.

“By routinely testing people at-risk of developing heart disease for levels of NT-proBNP, doctors are able to diagnose the condition earlier and more accurately, which can have a significant impact on the long term health outcomes of patients. It enables the detection of even early stages of heart failure, a time in the disease process where there are generally no obvious symptoms”, said Dr. Bayes-Genis.

NT-proBNP is an inactive protein with a long half-life, thus it is more stable,, and remains in the blood stream longer than other markers., This makes NT-proBNP a more sensitive test for use in the early detection and management of congestive heart failure.

Cardiovascular disease, including heart failure, is still the single most common cause of death worldwide. Unlike many conditions, heart failure is expected to continue to rise, due to ageing populations, the adoption of increasingly Westernised lifestyles and increased survival after other cardiovascular events. The incidence of heart failure in India is growing at a rate of 1.57million cases each year.

“Indians are more susceptible to heart failure, due to genetic pre-disposition as well as changes in dietary habits and lack of physical exercise. The NT-proBNP test can assist in the early diagnosis of heart failure which could reduce the incidence in the country,” said Dr Bhuwnesh Agrawal, Managing Director and Chairman of Roche Diagnostics, India.

As heart failure is a degenerative condition, it is not reversible and therefore an early and accurate diagnosis is crucial to ensure positive healthcare outcomes for patients. However, the condition is difficult to diagnose as early symptoms are non-specific and similar to those observed in many pulmonary disorders. As many as 50% of patients referred to cardiologists by general practitioners are initially misdiagnosed.

“The understanding of heart failure is still relatively low both among the public and healthcare professionals,” said Dr Bayes-Genis. “Yet early and accurate diagnosis can significantly impact treatment outcomes, and could moderate or even halt disease progression. Therefore it is important to fully utilise NT-proBNP and incorporate it into routine screening for at-risk patients. As NT-proBNP can detect even mild and moderate stages of the disease, it has been proven to be the most reliable and accurate marker to diagnose and assess a person’s risk of heart failure.”

NT-proBNP was approved by the US Food and Drug Administration (FDA) as an objective marker for the diagnosis and prognosis of heart failure as well as the risk assessment in patients with acute coronary syndrome. It also offers strong prognostic value to help assess the increased risk of cardiovascular events and mortality in patients with stable coronary artery disease.

In addition to its diagnostic and prognostic capabilities, NT-proBNP is being evaluated to guide treatment, to ensure patients receive the appropriate form and level of treatment, reducing cardiovascular event and ultimately improving patient management.

The potential benefit of regular NT-proBNP screening is particularly significant for at-risk population groups. High-risk patient groups include people suffering from diabetes, high cholesterol, high blood pressure, known coronary artery disease, or those aged 60 years and older among others.

“Regular screening of at-risk patients’ NT-proBNP levels can not only help save lives, but will also significantly reduce the patient’s cost burden. Medical and lifestyle interventions can be very effective treatment options for mild- to moderate heart failure. However, it is crucial that they are started early as the damage done to the heart in the severe stages of the disease is irreversible and ultimately fatal,” concluded Dr Bayes-Genis.

References for the article:

  1. Januzzi, JL. Comments from the International NT-proBNP Consensus Panel. Presented at: proCardio Symposium, Baveno, Italy. 2008.
  2. Mair, J. et al. The impact of cardiac natriuretic peptide determination on the diagnosis and management of heart failure. Clinical Chemistry & Laboratory Medicine 2001; 39: 571-588.
  3. Ordonez-Llanos, J. NT-proBNP: Analutical Considerations. In: NT-proBNP as a biomarker in cardiovascular diseases. Eds: Bayes-Genis, A. and Januzzi, JL. Thomson Reuters, 2008.
  4. Elin, RJ. et al. Laboratory and clinical aspects of B-type natriuretic peptides. Archives of Pathology and Laboratory Medicine 2004; 128: 697-699.
  5. Pemberton, CJ. et al. Deconvolution analysis of cardiac natriuetic peptides during acute volume overload. Hypertension 2000; 36: 355-359.
  6. World Health Organisation. The Atlas of Heart Disease and Stroke. 2004. Accessed on 3 October 2008 at: http://www.who.int/cardiovascular_diseases/resources/atlas/en/
  7. Joint scientific symposium of ICMR and university of Minesota
  8. National Heart, Lung, and Blood Institute. National Institutes of Health Data Fact Sheet: Congestive Heart Failure. September 1996.
  9. Roche Diagnostics. Data on File 2002.
  10. Roche Diagnostics. Elecsys proBNP – A novel approach for the management of heart failure.