Natriuretic peptide‐guided treatment to prevent cardiovascul | Figure 1

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Natriuretic peptide‐guided treatment to prevent cardiovascular events in those without heart failure

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Review question

We wanted to see if natriuretic peptide (NP)‐guided treatment is better than usual care for preventing death and cardiovascular events among patients with risk factors for heart disease but without heart failure.

Background

Cardiovascular diseases (CVDs) are a group of conditions that affect the heart and blood vessels. They are the leading causes of avoidable death worldwide. Risk factors that increase a person's likelihood of developing CVD include diabetes, high blood pressure, high cholesterol, and obesity. Natriuretic peptides (NPs) are hormones produced by the heart that are measured in the blood. They help the body to eliminate fluids, relax the blood vessels, and funnel sodium into the urine. When the heart is damaged, the body releases more NPs to try to ease strain on the heart. By measuring a person's blood NP levels, we can identify those who have established damage to their heart and who are at higher risk of death and cardiovascular events such as heart attack and stroke. We can then use this information to reduce a person's cardiovascular risk by guiding decisions about their cardiovascular care (NP‐guided treatment), such as what medication they should take, what investigations they need, and what adjustments they should make to their lifestyle.

Study characteristics

Evidence in this review is current to July 2019. We included two randomised controlled trials (where participants have an equal chance of being assigned to either treatment) including 1674 adult participants who had one or more risk factors for developing CVD, which compared NP‐guided treatment with standard care. We excluded patients with symptoms of heart failure. The mean age of participants varied between 64.1 and 67.8 years. Patients were followed‐up for between 2 years and a mean of 4.2 years.

Key results

Effects of NP‐guided treatment on death due to CVD or for any other reason remain uncertain as our results were imprecise. Moderate‐quality evidence suggests that NP‐guided treatment probably reduces the number of hospitalisations due to cardiovascular events and due to all causes in patients with cardiovascular risk factors. We would expect that of 1000 patients who received standard care, 163 would be admitted to hospital as the result of a cardiovascular event, compared to between 65 and 111 patients who received NP‐guided treatment. Out of 1000 patients with cardiovascular risk factors who received standard care, 601 would be admitted to hospital for any reason, compared to between 457 and 553 patients who received NP‐guided treatment.

High‐quality evidence indicates that NP‐guided treatment reduces the risk of ventricular dysfunction (a condition that often leads to heart failure) compared to standard care. Our results suggest that of 1000 patients with cardiovascular risk factors who received standard care, 87 would develop ventricular dysfunction, compared to between 36 and 79 patients who received NP‐guided treatment. No evidence suggests that NP‐guided treatment affected NP level at completion of the studies.

Quality of the evidence

The quality of evidence ranged from low to high across outcomes. Key reasons for concern about the quality of the evidence included risk of bias, as patients and medical staff caring for patients knew whether they were in the control or intervention group and this may have affected the care they received; some results obtained were imprecise, and it is unclear if the intervention was beneficial or harmful. As we identified only two studies that were suitable for inclusion in this review, the generalisability of the review is limited.

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