e in 5 cases, cancer in 4, unknown in 5, and sudden death in 3. Pancreatitis, infection, renal failure, digestive bleeding, bowel ischemia, and cholecystitis accounted for 1 death each. At multivariate Cox regression analysis, NT-proBNP was an independent predictor of the outcome of new cancer diagnosis, heart failure or death, along with age and use of acenocumarol and insulin (Table 3).
Patients with CAD have increased probabilities of developing malignancies. This is so because the incidence of cancer increases with age [1], tobacco consumption and some dietary patterns that promote CAD [2,3]. Thus, predicting the risk of cancer in patients with CAD could be of interest.
Linear regressions showing the correlations of NT-proBNP with age and other biomarkers studied. Correlations were significant but mild with age, Glomerular Filtration Rate (GFR) as assessed by the Chronic Kidney Disease Epidemiology Collaboration Method (CKD-EPI), high-sensitivity C-reactive protein (hs-CRP), high-sensitivity cardiac troponin I (hs-cTnI), monocyte chemoattractant protein-1 (MCP-1), galectin-3 (Gal3), and triglyceride TY-52156 plasma levels. Log: Logarithm.NT-proBNP is derived from pre-proBNP secreted by the ventricular myocardium [14] and is used mainly for the diagnosis of heart failure [15]. In addition, it may predict the development of heart failure and death in patients with cardiovascular disease [13,14]. However, NTproBNP could have predictive power beyond cardiovascular risk. In fact, this biomarker is associated with total death in patients with cardiovascular diseases [14] and in elderly subjects [169]. We describe for the first time that NT-proBNP is also an independent predictor of the appearance of malignancies in patients with CAD. Until now, natriuretic peptides have been investigated as predictors of cardiac toxicity secondary to chemotherapy [20]. More recently, a possible relationship between natriuretic peptide plasma levels and cancer itself has been suggested. In fact, patients with cancer may have elevated BNP levels in the absence of volume overload [6,21]. In patients over 40 years of age with previous elective non-cardiac surgery, NT-proBNP levels equal to or higher than 125 pg/ml were independently associated with a diagnosis of lung cancer after excluding patients with heart failure, CAD, and other conditions known to affect this biomarker [22]. Although natriuretic peptides had been shown to be secreted by small-cell lung cancer [4,5], only 15% of the cases reported in this study, and one in the present paper, had this type of cancer, suggesting that other tumors could also produce NT-proBNP. In addition, NT-proBNP was an independent predictor of survival in patients with non-Hodgkin lymphoma treated with chemotherapy, after excluding those who were candidates for palliative chemotherapy and those with human immunodeficiency virus infection [23]. Twelve percent had previous heart disease and the median ejection fraction was 65%. Of interest, NT-proBNP levels were associated with the involvement of two or more extranodal sites, suggesting a potential relationship with the stage of this malignancy. Similarly, increased NT-proBNP plasma levels predict the progression of metastatic renal carcinoma [24]. Although hematological and lung cancer seem to have been especially related to NT-proBNP levels, in our series there were no differences in plasma levels of this biomarker among these groups of patients with cancer, and the groups of pat
