Natriuretic peptide‐guided treatment for the prevention of cardiovascular events in patients without heart failure

Background Cardiovascular disease (CVD) is the leading cause of morbidity and mortality globally. Early intervention for those with high cardiovascular risk is crucial in improving patient outcomes. Traditional prevention strategies for CVD have focused on conventional risk factors, such as overweight, dyslipidaemia, diabetes, and hypertension, which may reflect the potential for cardiovascular insult. Natriuretic peptides (NPs), including B‐type natriuretic peptide (BNP) and N‐terminal pro B‐type natriuretic peptide (NT‐proBNP), are well‐established biomarkers for the detection and diagnostic evaluation of heart failure. They are of interest for CVD prevention because they are secreted by the heart as a protective response to cardiovascular stress, strain, and damage. Therefore, measuring NP levels in patients without heart failure may be valuable for risk stratification, to identify those at highest risk of CVD who would benefit most from intensive risk reduction measures. Objectives To assess the effects of natriuretic peptide (NP)‐guided treatment for people with cardiovascular risk factors and without heart failure. Search methods Searches of the following bibliographic databases were conducted up to 9 July 2019: CENTRAL, MEDLINE, Embase, and Web of Science. Three clinical trial registries were also searched in July 2019. Selection criteria We included randomised controlled trials enrolling adults with one or more cardiovascular risk factors and without heart failure, which compared NP‐based screening and subsequent NP‐guided treatment versus standard care in all settings (i.e. community, hospital). Data collection and analysis Two review authors independently screened titles and s and selected studies for inclusion, extracted data, and evaluated risk of bias. Risk ratios (RRs) were calculated for dichotomous data, and mean differences (MDs) with 95% confidence intervals (CIs) were calculated for continuous data. We contacted trial authors to obtain missing data and to verify crucial study characteristics. Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, two review authors independently assessed the quality of the evidence and GRADE profiler (GRADEPRO) was used to import data from Review Manager to create a 'Summary of findings' table. Main results We included two randomised controlled trials (three reports) with 1674 participants, with mean age between 64.1 and 67.8 years. Follow‐up ranged from 2 years to