Elevated NT-ProBNP as a Cardiovascular Disease Risk Equivalent: Evidence from the Atherosclerosis Risk in Communities (ARIC) Study - 17/11/22
, Sui Zhang, MPP b, John William McEvoy, MBBS, MHS c, Chiadi E. Ndumele, MD, PhD d, Ron C. Hoogeveen, PhD e, Josef Coresh, MD, PhD b, Elizabeth Selvin, PhD, MPH bAbstract |
Background |
It remains unclear whether elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) can serve as a “risk equivalent” for cardiovascular disease to adults at high cardiovascular risk.
Methods |
We included 9789 participants (mean age 63.2 years, 55% women, 19.4% Black, 13% with a history of cardiovascular disease) who attended Atherosclerosis Risk in Communities Study Visit 4 (1996-1998). We classified participants as having a history of cardiovascular disease at baseline and, among those without cardiovascular disease, we defined categories of NT-proBNP (<125, 125-449, ≥450 pg/mL). We used Cox regression to estimate associations of NT-proBNP with incident cardiovascular disease and mortality.
Results |
Over a median 20.5 years of follow-up, there were 4562 deaths (917 cardiovascular deaths). There were 2817 first events and 806 recurrent events (in those with a history of cardiovascular disease at baseline). Among individuals without a history of cardiovascular disease, those adults with NT-proBNP ≥450 pg/mL had significantly higher risks of all-cause death (hazard ratio [HR] 2.12; 95% confidence interval [CI], 1.78-2.53), cardiovascular mortality (HR 2.92; 95% CI, 2.15-3.97), incident total cardiovascular disease (HR 2.59; 95% CI, 2.13-3.16), atherosclerotic cardiovascular disease (HR 2.20; 95% CI, 1.72-2.80), and heart failure (HR 3.81; 95% CI, 3.01-4.81), compared with individuals with NT-proBNP <125 pg/mL. The elevated cardiovascular risk in persons with high NT-proBNP and no history of cardiovascular disease was similar to, or higher than, the risk conferred by a history of cardiovascular disease.
Conclusions |
Our findings suggest that it might be appropriate to manage adults with NT-proBNP ≥450 pg/mL as if they had a history of clinical cardiovascular disease.
Le texte complet de cet article est disponible en PDF.Keywords : Cardiac biomarkers, Cardiovascular risk, Epidemiology
Plan
| Funding: The Atherosclerosis Risk in Communities study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NHI), Department of Health and Human Services, under contract nos. HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I. The content of this work is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Justin B. Echouffo-Tcheugui was supported by NIH/NHLBI grant K23 HL153774. Elizabeth Selvin was supported by NIH/National Institute of Diabetes and Digestive and Kidney Diseases grants K24 HL152440, R01DK089174. |
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| Conflicts of Interest: No potential conflicts of interest relevant to this article were reported. |
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| Authorship: All authors had access to the data and a role in writing this manuscript. The data are available from the authors upon request. |
Vol 135 - N° 12
P. 1461-1467 - décembre 2022 Retour au numéro
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