Elevated NT-proBNP as Equivalent to Cardiovascular Disease Risk

1. In this prospective cohort study, participants with elevation of N-terminal pro-B-type natriuretic peptide (NT-proBNP ≥ 450 pg/mL) were found to have similar cardiovascular disease and mortality compared to participants with a history of cardiovascular disease.

2. Participants with high NT-proBNP ≥ 450 pg/mL have a significantly higher risk of all-cause death and cardiovascular mortality

Level of evidence assessment: 2 (good)

N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a good predictor of cardiovascular events, especially heart failure (HF). Currently, guidelines do not recommend the use of cardio biomarkers such as NT-proBNP for clinical decision making in people without overt HF. However, the guidelines suggest that additional evidence on the prognostic value of cardio biomarkers could lead to future guideline changes. Elevated NT-proBNP can aid in patient risk stratification and help identify otherwise asymptomatic high-risk individuals. This study hypothesizes the existence of a fraction of individuals in the community at high risk of cardiovascular mortality without a significant history of disease, which could be identified using NT-proBNP. This study was a prospective cohort analysis of the Atherosclerosis Risk in Communities (ARIC) study. In total, the final group consisted of 9,789 participants between the ages of 54 and 76 from four communities in the United States. Patients were followed for over twenty years, with a baseline beginning between 1996 and 1998. Participants without cardiovascular disease were categorized by NT-proBNP, <125, 125 - 449, and ≥450 pg/mL. Endpoints analyzed included cardiovascular events such as coronary heart disease, stroke, and heart failure, and participants were followed through December 2019. For baseline characteristics, 13% of initial participants had a history of cardiovascular disease, and in comparison, adults in the NT-proBNP ≥ 450 pg/mL group were older, had a lower BMI, were more likely to be female, Caucasian, and older. likely to suffer from hypertension, diabetes mellitus or chronic kidney disease. Overall, there were 4,562 deaths, with higher levels of NT-proBNP being linearly associated with the risk of death. Participants with the highest NT-proBNP levels had similar or higher rates of cardiovascular disease and mortality compared to those with known cardiovascular disease. Additionally, when comparing the highest NT-proBNP group (≥450 pg/mL) to the lowest group (<125 pg/mL), the higher group had significantly higher risks of death from all causes. , cardiovascular mortality, cardiovascular disease, atherosclerotic disease, and heart failure. Overall, the results of this study suggest that NT-proBNP elevation is an equivalent of cardiovascular risk and is useful for monitoring cardiovascular risk in the community setting. A limitation of this study is that given the population of participants, the results cannot be applied to the general population, but this study is an excellent and promising first step in the use of NT-proBNP for risk stratification. .

Click to read the study in AM JMED

Picture: PD

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