Elevated NT-ProBNP as a Cardiovascular Disease Risk Equivalent: Evidence from the Atherosclerosis Risk in Communities (ARIC) Study |
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| Affiliation: | 1. Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD;2. Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;3. Division of Cardiology and National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland;4. Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD;5. Section of Cardiovascular Research, Baylor College of Medicine & Houston Methodist DeBakey Heart and Vascular Center, Houston, TX;1. University of Pittsburgh Medical Center, Pa;2. Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Conn;3. Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn;4. Department of Health Policy and Management, Yale School of Public Health, New Haven, Conn;5. Section of Endocrinology and Metabolism, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn;1. Department of Pathology, Microbiology, and Immunology;2. Division of Infectious Diseases, New York Medical College, Valhalla, NY;1. Heart Institute, Hadassah Medical Center, Jerusalem and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel;2. Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel;1. Northwestern University Feinberg School of Medicine, Chicago, Ill;2. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn;3. Department of Medicine (Cardiology) and Preventive Medicine, Vascular Center of the Bluhm Cardiovascular Institute of Northwestern Memorial Hospital, Chicago, Ill;1. Loyola University Chicago Stritch School of Medicine, Maywood, Ill;2. Department of Otolaryngology Head and Neck Surgery, Loyola University Medical Center, Maywood, Ill |
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| Abstract: | BackgroundIt 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.MethodsWe 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.ResultsOver 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.ConclusionsOur 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. |
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