TY - JOUR
T1 - Elevated NT-ProBNP as a Cardiovascular Disease Risk Equivalent
T2 - Evidence from the Atherosclerosis Risk in Communities (ARIC) Study
AU - Tcheugui, Justin Basile
AU - Zhang, Sui
AU - McEvoy, John William
AU - Ndumele, Chiadi E.
AU - Hoogeveen, Ron C.
AU - Coresh, Josef
AU - Selvin, Elizabeth
N1 - Funding Information:
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 .
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/12
Y1 - 2022/12
N2 - 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.
AB - 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.
KW - Cardiac biomarkers
KW - Cardiovascular risk
KW - Epidemiology
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U2 - 10.1016/j.amjmed.2022.07.012
DO - 10.1016/j.amjmed.2022.07.012
M3 - Article
C2 - 36007589
AN - SCOPUS:85139026280
SN - 0002-9343
VL - 135
SP - 1461
EP - 1467
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 12
ER -