Elevated plasma natriuretic peptide levels were associated with cardiovascular events.

M e t h o d s Design: Cohort study with mean 5.2-year follow-up (Framingham Offspring Study). Setting: Community-based study in the United States. Patients: 3346 participants (mean age 58 y, 53% women) of the Framingham Off-spring Study. Exclusion criteria were HF, serum creatinine > 177 μmol/L (> 2.0 mg/dL), unavailable natriuretic peptide levels, or missing covariate or follow-up data. Risk factors: B-type natriuretic peptide (BNP) and N-terminal proatrial natriuretic peptide (N-ANP) measured using highsensitivity, noncompetitive immunoradiometric assays. Other risk factors were age, sex, presence or absence of hypertension and diabetes, ratio of total–to–high-density lipoprotein cholesterol, body mass index, serum creatinine level, and smoking status. Outcomes: All-cause mortality, a first major cardiovascular event (recognized myocardial infarction, coronary insufficiency, death from coronary heart disease, HF, and stroke), HF, atrial fibrillation, stroke or transient ischemic attack, and coronary heart disease events (recognized or unrecognized myocardial infarction, coronary insufficiency, and angina pectoris).