Serial NT-proBNP measurements improve risk stratification of patients with pre-Heart Failure

U.S.A: A new study found that serial N-terminal B-type natriuretic peptide (NT-proBNP) measurements helped in risk stratification of patients with pre-Heart Failure. A 6-year change in NT-proBNP has shown a dynamic change in risk for HF events and death among community-dwelling adults without prevalent clinical HF. The study results were published in the journal JAMA Cardiology.  

NT-proBNP is a well-established biomarker in the diagnosis and prognosis of Heart failure. Incident heart failure events were associated with elevated levels of circulating NT-proBNP. As most of the past guidelines stated that patients with higher NT-proBNP levels were classified as pre-HF, researchers conducted a study to evaluate if NT-proBNP level alterations are associated with future cardiovascular risk among middle-aged individuals without prevalent HF and assess changes in modifiable risk factors like the blood pressure, lipids, and BMI, are associated with a change in NT-proBNP. 

Participants enrolled in the Atherosclerosis Risk in Community (ARIC) study from 4 US communities were recruited for the study. Individuals who attended ARIC visit 2 and 4 with 6 years apart and who were having NT-proBNP measurements without any prevalent HF were included in the study. Assays of NT-proBNP were carried out between 2011 and 2013, and analysis was done between July 2021 and October 2022. NT-proBNP change between visits 2 and 4 was the primary exposure variable, modeled as change categories (<125 pg/mL or ≥125 pg/mL) and as percent change. Incident HF hospitalization and all-cause death were the primary outcome measures. Changes in cardiovascular risk factors with consequent changes in NT-proBNP levels were also assessed. 

Key findings: 

• There were a total of 9776 individuals with a mean [SD] age, of 57.1 [5.7] years at visit 2 and out of which 5523 [56.5%] were women. 
• There was a high risk of incident HF and mortality risk in participants with NT-proBNP level of 125 pg/mL or higher at both visits when compared with participants with NT-having proBNP level less than 125 pg/mL at both visits. 
• The risk of HF and death in participants with NT-proBNP levels of 125 pg/mL or higher at visit 2 and less than 125 pg/mL at visit 4 was similar to the group with NT-proBNP levels of less than 125 pg/mL at both visits.
• The percent change in NT-proBNP was positively associated with HF and death. 
• Changes in the levels of systolic blood pressure, low-density lipoprotein cholesterol, triglyceride level, body mass index, and estimated glomerular filtration rate were significantly associated with changes in NT-proBNP.  

Thus, change in NT-proBNP over 6 years was associated with the risk of incident HF and mortality among middle-aged adults without clinical HF. 

Further reading: Jia X, Al Rifai M, Hoogeveen R, et al. Association of Long-term Change in N-Terminal Pro–B-Type Natriuretic Peptide With Incident Heart Failure and Death. JAMA Cardiol. Published online February 08, 2023. doi: 10.1001/jamacardio.2022.5309