NT-proBNP less than 1000 pg/mL predicts better CV outcomes Irrespective of Obesity Status
Obesity is a growing epidemic worldwide and a major risk factor for the development of heart failure (HF). N-terminal pro-B-type NP (NT-proBNP), one of the gold standard biomarkers for risk stratification, diagnosis, and prognostication in heart failure. Previous studies suggest that the presence of NT-proBNP levels were low in obese individuals.
In a recent study, researchers have found that NT‐proBNP levels are the strongest prognostic markers for adverse cardiovascular events irrespective of the obesity status. They also reported that NT‐proBNP levels less than ≤1000 pg/mL has favourable prognostic implications. The research has been published in the Journal of the American Heart Association on March 23, 2021.
The results from the multicenter, randomized GUIDE‐IT (Guiding Evidence‐Based Therapy Using Biomarker‐Intensified Treatment in HF) trial, evaluating the role of NT‐proBNP levels to guide HF management, were neutral. Secondary analyses from the GUIDE‐IT trial and prior studies indicate that those who achieved the NT‐proBNP levels of ≤1000 pg/mL had a lower risk of adverse cardiovascular events. However, the prognostic implications of having on‐treatment NT‐proBNP ≤1000 pg/mL in obese patients with HF receiving biomarker‐guided HF therapy are not known. Therefore, researchers of the University of Alabama at Birmingham conducted a study to evaluate the prognostic implications of obesity and having NT‐proBNP levels (≤1000 pg/mL) in the GUIDE‐IT trial participants.
In this post-hoc analysis, researchers assessed the risk of adverse cardiovascular events (HF hospitalization or cardiovascular mortality) using multivariable‐adjusted Cox proportional hazard models based on having NT‐proBNP ≤1000 pg/mL, stratified by obesity status. They also assessed the study outcomes based on the body mass index at baseline. The predictive ability of NT‐proBNP for adverse cardiovascular events was assessed using the likelihood ratio test.
Key findings of the study were:
- Upon analysis, the researchers found that NT‐proBNP levels were 59.0% lower among obese individuals.
- They also found a lower risk of adverse cardiovascular events in obese (hazard ratio [HR], 0.48) and nonobese (HR, 0.32) patients with HF who had NT‐proBNP levels ≤1000 pg/mL, compared with those who did not.
- They noted no interaction between obesity and having NT‐proBNP ≤1000 pg/mL on the study outcome.
- They also noted that obese patients are at higher risk of developing adverse cardiovascular events (HR, 1.39) compared with nonobese patients.
- They reported NT‐proBNP as the strongest predictor of adverse cardiovascular event risk in both obese and nonobese patients.
The authors concluded, "On‐treatment NT‐proBNP level ≤1000 pg/mL has favourable prognostic implications, irrespective of obesity status. NT‐proBNP levels were the strongest predictor of cardiovascular events in both obese and nonobese individuals in this trial."
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