NT-proBNP associated with risk for incident heart failure and all-cause mortality

1. In this prospective cohort study, among 9776 individuals, an NT-proBNP level of 125pg/mL or higher was associated with risk for incident heart failure and mortality.

2. Changes in systolic blood pressure, low-density lipoprotein cholesterol, triglyceride levels, body mass index, and estimated glomerular filtration rate were found to be significantly associated with changes in NT-proBNP.

Evidence Rating Level: 2 (Good)

Study Rundown: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a biomarker used in the diagnosis and prognosis of patients with heart failure (HF). Elevated NT-proBNP levels in patients with established cardiovascular disease have been consistently associated with incident clinical HF events, coronary heart disease, stroke and all-cause mortality, among other outcomes. The objective of this study was to assess the association between change in NT-proBNP and risk for incident HF and death. The primary exposure variable was NT-proBNP change between visits 2 and 4, which were approximately 6 years apart. The primary outcomes were incident HF hospitalization and all-cause mortality. A total of 9776 individuals were included in this study. Participants with NT-proBNP levels of 125 pg/mL or higher at both visits were found to have an increase in incident HF and mortality risk, compared to those with NT-proBNP levels less than 125 pg/mL. The percent change in NT-proBNP was positively associated with HF and death. Factors significantly associated with a change in NT-proBNP included changes in systolic blood pressure, low-density lipoprotein cholesterol, triglyceride levels, body mass index, and estimated glomerular filtration rate. This study demonstrated that persistently elevated levels of NT-proBNP were associated with the highest risk of incident HF and all-cause mortality. A major strength of this study was its large sample size. A limitation was that due to the large gap of 6 years between visits, the study could not account for potential fluctuations in biomarkers between visits 2 and 4, and how such variations could affect cardiovascular risk.

Click to read the study in JAMA Cardiology

Relevant Reading: Risk factors for pre-heart failure or symptomatic heart failure based on NT-proBNP

In-Depth [prospective cohort]: This study assessed the association between change in NT-proBNP and risk for incident HF and death. A total of 9776 individuals were recruited from 4 US communities enrolled in the Atherosclerosis Risk in Community (ARIC) study (mean [SD] age, 57.1 [5.7] years at visit 2; 5523 [56.5%] women). The primary exposure variable was NT-proBNP change between visits 2 and 4, modelled as change categories (<135pg/mL or ≥ 125 pg/mL) and as percent change. The primary outcomes were incident HF hospitalization and all-cause mortality. Participants with NT-proBNP levels of 125 pg/mL or higher at both visits were found to have an increase in incident HF (adjusted hazard ratio [HR], 2.40 [95% CI, 2.00 – 2.88]) and mortality risk (HR, 1.68 [95% CI, 1.47 – 1.91), compared to those with NT-proBNP levels less than 125 pg/mL. Compared with the group with NT-proBNP levels of less than 125 pg/mL at both visits, participants with an NT-proBNP of 125 pg/mL or higher at visit 2 and less than 125 pg/mL at visit 4 had a similar risk for HF and death (HR, 1.01 [95% CI, 0.71 – 1.43]; HR, 0.79 [95% CI, 0.61 – 1.01]). The median (IQR) change in NT-proBNP over the approximately 6 years between visits was 21.8 (0.5 – 59.3) pg/mL. The percent change in NT-proBNP was positively associated with HF and death (HR, 1.06 [95% CI, 1.02 – 1.10]; HR, 1.05 [95% CI, 1.03 – 1.08]).

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