Elevated NT-proBNP as a cardiovascular disease risk equivalent: Evidence from the Atherosclerosis Risk in Communities (ARIC) Study



      It remains unclear whether elevated NT-proBNP can serve as a ‘risk equivalent’ for cardiovascular (CVD) to adults at high cardiovascular risk.


      We included 9,789 participants (mean age 63.2 years, 55% women,19.4% Black, 13% with a history of cardiovascular disease) who attended ARIC 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 NTproBNP with incident cardiovascular disease and mortality.


      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% 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 to individuals with NT-proBNP<125 pg/mL. The elevated cardiovascular risk in persons with high NTproBNP and no history of cardiovascular disease was similar to or higher than the risk conferred by a history of cardiovascular disease.


      Our findings suggest that it might be appropriate to manage adults with NTproBNP ≥450 pg/mL as if they had a history of clinical cardiovascular disease.

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