***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Heart failure ( HF ) is an important cause of morbidity in patients with acute coronary syndromes ( ACS ) .  C-reactive protein ( CRP ) has been implicated in experimental models as exacerbating myocardial injury , but data regarding the clinical relationship of high-sensitivity CRP ( hsCRP ) and B-type natriuretic peptide ( BNP ) concentrations with the risk of HF after ACS are few . METHODS PROVE IT-TIMI 22 r and omized 4162 patients who had been stabilized after ACS to either intensive or moderate statin therapy .  hsCRP and BNP  were measured 30 days after r and omization . Hospitalizations for HF and cardiovascular death occurring after day 30 were assessed for a mean follow-up of 24 months . RESULTS Patients who developed HF had higher concentrations of hsCRP ( 3.7 mg/L vs 1.9 mg/L , P < 0.001 ) and BNP ( 59 ng/L vs 22 ng/L , P < 0.0001 ) . HF increased in a stepwise manner with hsCRP quartile [ adjusted hazard ratio ( HR(adj ) ) for Q4 vs Q1 , 2.5 ; P = 0.01 ] and BNP quartile ( HR(adj ) for Q4 vs Q1 , 5.8 ; P < 0.001 ) , with similar results obtained for HF and cardiovascular death . In a multivariable analysis , higher concentrations of hsCRP and BNP were both independently associated with HF [ HR(adj ) , 1.9 for hsCRP > 2.0 mg/L ( P = 0.01 ) and 4.2 for BNP > 80 ng/L ( P < 0.001 ) ] . Patients with increases in both markers were at the greatest risk of HF , compared with patients without an increased marker concentration ( HR(adj ) , 8.3 ; P = 0.01 ) . The benefit of intensive statin therapy in reducing HF was consistent among all patients , regardless of hsCRP or BNP concentration . CONCLUSIONS Both hsCRP and BNP measured 30 days after ACS are independently associated with the risk of HF and cardiovascular death , with the greatest risk occurring when both markers are increased AIMS This study evaluated the predictive value of NT-proBNP for patients with diabetes mellitus and compared the prognostic aptitude of this neurohumoral marker to traditional markers of cardiovascular events . METHODS AND RESULTS A prospect i ve observational study was conducted in 631 diabetic patients . The composite endpoint consisted of unplanned hospitalization for cardiovascular events or death within the observation period of 12 months . Of all variables analysed ( age , gender , history of hypertension , ischaemic heart disease/any cardiac disease , smoking , duration of diabetes , body mass index , blood pressure , New York Heart Association-class , Dyspnoea score , Minnesota Living with Heart Failure Question naire , LDL-cholesterol , HbA(1c ) , creatinine , glomerular filtration rate ) , the logarithm of NT-proBNP gave the most potent information in a stepwise Cox regression analysis ( P < 0.0001 ) . Bootstrapping with 500 sample s supports this result in 95 % sample s. The negative predictive value of a normal value ( < 125 pg/mL ) of NT-proBNP for short-term cardiovascular events in diabetic patients is 98 % . CONCLUSION We have demonstrated a strong and independent correlation between NT-proBNP and short-term prognosis of cardiovascular events for patients with diabetes mellitus . With a high negative predictive value it can identify individuals who are not at intermediate risk for cardiovascular events .  NT-proBNP proved to be of higher predictive value than traditional cardiovascular markers , in this unselected cohort CONTEXT Identification of individuals at high risk for cardiovascular events is important for the optimal use of primary and secondary prevention measures . OBJECTIVE To determine whether plasma levels of amino terminal fragment of the prohormone brain-type natriuretic peptide ( NT-proBNP ) predict cardiovascular events or death independent of other available prognostic tests . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study ( 2000 - 2002 ) of 987 individuals in California with stable coronary heart disease in the Heart and Soul Study , who were followed up for a mean of 3.7 ( range , 0.1 - 5.3 ) years . MAIN OUTCOME MEASURES The association of baseline NT-proBNP levels with death or cardiovascular events ( myocardial infa rct ion , stroke , or heart failure ) . Traditional clinical risk factors , echocardiographic measures , ischemia , other biomarkers , and New York Heart Association classification were adjusted for to determine whether NT-proBNP levels were independent of other prognostic factors . Receiver operating characteristic ( ROC ) curves were used to assess the incremental prognostic value of adding NT-proBNP level to these other measures . RESULTS A total of 256 participants ( 26.2 % ) had a cardiovascular event or died . Each increasing quartile of NT-proBNP level ( range of quartile 1 , 8.06 - 73.95 pg/mL ; quartile 2 , 74 - 174.5 pg/mL ; quartile 3 , 175.1 - 459 pg/mL ; quartile 4 , > or = 460 pg/mL ) was associated with a greater risk of cardiovascular events or death , ranging from 23 of 247 ( annual event rate , 2.6 % ) in the lowest quartile to 134 of 246 ( annual event rate , 19.6 % ) in the highest quartile ( unadjusted hazard ratio [ HR ] for quartile 4 vs quartile 1 , 7.8 ; 95 % confidence interval [ CI ] , 5.0 - 12.1 ; P<.001 ) . Each SD increase in log NT-proBNP level ( 1.3 pg/mL ) was associated with a 2.3-fold increased rate of adverse cardiovascular outcomes ( unadjusted HR , 2.3 ; 95 % CI , 2.0 - 2.6 ; P<.001 ) , and this association persisted after adjustment for all of the other prognostic measures ( adjusted HR , 1.7 ; 95 % CI , 1.3 - 2.2 ; P<.001 ) . The addition of NT-proBNP level to st and ard clinical assessment and complete echocardiographic parameters significantly improved the area under the ROC curves for predicting subsequent adverse cardiovascular outcomes ( 0.80 for clinical risk factors and echocardiographic parameters plus log NT-proBNP vs 0.76 for clinical risk factors and echocardiographic parameters only ; P = .006 ) . CONCLUSIONS Elevated levels of NT-proBNP predict cardiovascular morbidity and mortality , independent of other prognostic markers , and identify at-risk individuals even in the absence of systolic or diastolic dysfunction by echocardiography . Level of NT-proBNP may help guide risk stratification of high-risk individuals , such as those with coronary heart disease Aims /hypothesisRaised N-terminal pro-brain natriuretic peptide ( NT-proBNP ) is independently associated with an increased risk of death in chronic heart failure and acute coronary syndromes in nondiabetic population s. Diabetic nephropathy is characterised by an increased risk of cardiovascular morbidity and mortality . This study investigated the prognostic value of NT-proBNP in a large cohort of type 1 diabetic patients with and without diabetic nephropathy . Methods In a prospect i ve observational follow-up study , 198 type 1 diabetic patients with overt diabetic nephropathy ( 122 men , age [ mean±SD ] 41±10 years , duration of diabetes 28±8 years , GFR 74±33 ml min−1 ) and a matched control group of 188 patients with longst and ing type 1 diabetes and persistent normoalbuminuria ( 114 men , age 43±10 years , duration of diabetes 27±9 years ) were followed for 9.3 ( 0.0–9.5 ) years . Plasma NT-proBNP concentration was determined by immunoassay at baseline . Results In patients with diabetic nephropathy , plasma NT-proBNP concentration was elevated to ( median [ range ] ) 110 ( 5–79640 ) ng l−1 vs. 27 ( 5–455 ) ng l−1 in normoalbuminuric patients ( p<0.0001 ) . Among patients with nephropathy , 39 ( 39 % ) patients with plasma NT-proBNP concentrations above the median and 12 ( 12 % ) with values below the median died from any cause ( unadjusted hazard ratio 3.86 [ 95 % CI 2.02–7.37 ] , p<0.0001 ; covariate-adjusted hazard ratio 2.28 [ 1.04–4.99 ] , p=0.04 ) . This lower mortality rate was attributable to fewer cardiovascular deaths : 31 ( 31 % ) and 7 ( 7 % ) above and below the median NT-proBNP level respectively ( unadjusted hazard ratio 5.25 [ 2.31–11.92 ] , p<0.0001 ; covariate-adjusted hazard ratio 3.81 [ 1.46–9.94 ] , p=0.006 ) . Conclusions /interpretationElevated circulating NT-proBNP is a new independent predictor of the excess overall and cardiovascular mortality in diabetic nephropathy patients without symptoms of heart failure OBJECTIVES The purpose of this work was to assess the prognostic role of glomerular filtration rate ( GFR ) and NT-terminal pro-B-type natriuretic peptide ( NT-proBNP ) for mortality end points in the vascular population . BACKGROUND The GFR and NT-proBNP have been shown to predict mortality end points in free-living and limited vascular population s , independent of traditional risk factors . However , their prognostic power in an unrestricted vascular population is poorly understood . METHODS A total of 412 subjects from a vascular cohort with a history of either peripheral arterial disease ( PAD ) and /or other cardiovascular disease ( CVD ) were included in this prospect i ve cohort analysis and followed for an average of 6.7 years . Outcome variables were all-cause mortality , ischemic heart disease ( IHD ) mortality , and any cardiovascular mortality . The prognostic roles of GFR and NT-proBNP levels were determined using multivariate survival analysis . RESULTS Higher GFR ( per 10 ml/min/1.73 m2 ) was significantly protective for all-cause mortality ( hazard ratio [ HR ] 0.81 , p < 0.001 ) , IHD mortality ( HR 0.82 , p = 0.008 ) , and CVD mortality ( HR 0.84 , p = 0.005 ) . Conversely , NT-proBNP was not a significant predictor of any mortality end point . The GFR showed the strongest association in subjects with a history of other CVD . Although NT-proBNP did not demonstrate a significant prognostic role in any of the subgroups , the data were suggestive for patients with PAD alone . CONCLUSIONS Glomerular filtration rate was a robust predictor of all-cause , IHD , and cardiovascular mortality in the vascular population , particularly in those with a history of other CVD , while NT-proBNP showed a suggestive association limited to the group with PAD only . These findings suggest that these markers must be selectively applied in the vascular population for greatest clinical utility Objective : To evaluate N-terminal pro-brain natriuretic peptide ( NT-proBNP ) as a diagnostic and prognostic marker for systolic heart failure in the general population . Design : Study participants , r and omly selected to be representative of the background population , filled in a heart failure question naire and underwent pulse and blood pressure measurements , electrocardiography , echocardiography , and blood sampling and were followed up for a median ( range ) period of 805 ( 60−1171 ) days . Setting : Participants were recruited from four r and omly selected general practitioners and were examined in a Copenhagen university hospital . Patients : 382 women and 290 men in four age groups ( 50−59 ( n = 174 ) ; 60−69 ( n = 204 ) ; 70−79 ( n = 174 ) ; ⩾ 80 years ( n = 120 ) ) . Main outcome measures : Value of NT-proBNP in evaluating patients with symptoms of heart failure and impaired left ventricular ( LV ) systolic function ; prognostic value of NT-proBNP for mortality and hospital admissions . Results : In 38 ( 5.6 % ) participants LV ejection fraction ( LVEF ) was ⩽ 40 % . NT-proBNP identified patients 
    Output:
    
Assay of BNP or NT-proBNP in addition to measurement of conventional CVD risk factors yielded generally modest improvements in risk discrimination .
Available prospect i ve studies indicate strong associations between circulating concentration of natriuretic peptides and CVD risk under a range of different circumstances .