Natriuretic peptides: Predictive, diagnostic and prognostic implications in cardiovascular diseases with particular regard to acute cardiovascular events

The involvement in the complex control of haemodynamic homeostasis and of cardiovascular remodeling underlies the pivotal role played by natriuretic peptides (NPs) in several cardiovascular diseases (CVD), with particular regard to acute cardiovascular events. A significant predictive role for CVD, including acute vascular events and death from cardiovascular causes, in apparently healthy subjects from the general population has been described in several epidemiological studies. NPs levels also exert a significant prognostic role towards the occurrence of major adverse cardiovascular events in patients with both stable and unstable coronary atherosclerotic disease and in patients with cerebrovascular accidents. In heart failure elevated circulating levels of NPs exert a key diagnostic role, and they also contribute to long-term prognostic stratification of patients. NPs levels are augmented in hypertension where they behave as a useful marker of future cardiovascular events, mainly related to end-organ damage. In addition, an altered natriuretic peptide structure, i.e., molecular variants of atrial natriuretic peptide (ANP), has been shown to contribute to the individual susceptibility to stroke and myocardial infarction in both animal models and in humans. The mechanisms of vascular damage directly dependent from ANP molecular variants are being actively explored in the attempt to improve our understanding of vascular diseases and to obtain key information for novel therapeutic and preventive strategies towards CVD occurrence. Of note, a potential application of NPs as therapeutic tool for the management of several CVD, including myocardial infarction, is currently under investigation with very promising results.