Serial NT-proBNP Predicts Long-Term Cardiovascular Risk in Older Adults: Study

A new study published in the journal of Annals of Internal Medicine revealed that serial measurement of N-terminal pro–B-type natriuretic peptide (NT-proBNP) may help identify cardiovascular risk even in asymptomatic, community-dwelling older adults without known cardiovascular disease. In the ASPREE trial and extension study, participants whose NT-proBNP levels rose above age-specific thresholds by year 3, either persistently or from a previously lower level, had a higher risk of cardiovascular events and mortality over the subsequent 8 years. Conversely, those who remained below the threshold had similarly favorable outcomes.

The findings are based on data from 8,454 community-dwelling older adults enrolled in the ASPREE (ASPirin in Reducing Events in the Elderly) trial and its observational extension, ASPREE-XT. Participants, with an average age of 78 years, were free of cardiovascular disease at the start of the study and had NT-proBNP levels measured at enrollment and again three years later.

This research classified participants into 4 heart stress categories based on changes in NT-proBNP levels: persistently heart stress-free, heart stress remission, incident heart stress, and sustained heart stress. They then followed participants for a median of 8 years to assess the occurrence of cardiovascular events and deaths.

During the follow-up period, this research recorded 818 cardiovascular events and 1,584 deaths. When compared to participants who remained heart stress-free, those who developed heart stress during the three-year period had a 7.4% higher adjusted absolute risk of cardiovascular disease and a 6.1% higher risk of all-cause mortality by year eight. Participants with sustained heart stress also experienced elevated risks, with a 6.7% increase in cardiovascular disease risk and a 7.5% increase in mortality risk.

The individuals whose heart stress resolved over the 3-year period had risks similar to those who remained heart stress-free throughout the study. This finding suggests that improving or stabilizing NT-proBNP levels may be associated with better long-term health outcomes.

The study's observational design could not establish a direct cause-and-effect relationship. In addition, most participants were White, which may limit the applicability of the findings to more diverse populations. Overall, the study suggests that monitoring changes in NT-proBNP over time could become a valuable tool for identifying older adults at increased risk of cardiovascular disease and premature death, enabling earlier preventive interventions and more personalized risk assessment.

Source:

Cai, A., Bayes-Genis, A., Wolfe, R., Tonkin, A. M., Zhu, C., Januzzi, J. L., Zheng, J., Nelson, M. R., Neumann, J. T., Woods, R. L., Tran, C., Pandey, A., Chen, L. Y., Feng, Y., Zhou, Y., Yan, B. P., Zhang, J., Liu, L., McNeil, J. J., … Zhou, Z. (2026). Longitudinal changes in heart stress and the risk for cardiovascular disease and mortality in older adults : An observational study: An observational study. Annals of Internal Medicine, ANNALS-26-00245. https://doi.org/10.7326/ANNALS-26-00245