Complex Relationships Between NT-proBNP, Heart Failure, and Obesity
What is the utility of N-terminal pro–B-type natriuretic peptide (NT-proBNP) for heart failure (HF) risk prediction among individuals with different obesity status in the ARIC (Atherosclerosis Risk in Communities) study?
ARIC is an ongoing prospective cohort study of 15,792 individuals enrolled from four US communities. In this analysis, the authors followed 12,230 participants free of prior HF at baseline. The authors quantified and compared the relative and absolute risk associations of NT-proBNP with incident HF across body mass index (BMI) categories.
There were 1,861 HF events during a median 20.6 years of follow-up. As expected, overall, NT-proBNP was inversely correlated with BMI (Pearson’s correlation coefficient: -0.10; p < 0.001). Higher BMI category at baseline was associated with higher rates of HF, with incidence rates (per 1,000 person-years) for those with normal weight of 5.6, overweight of 7.5, obesity of 11.6, and severe obesity of 16.8. Despite the inverse relationship between BMI and NT-proBNP, higher NT-proBNP levels were associated with greater relative risks of HF within each BMI category even after adjusting for ARIC HF risk score predictors.
Higher NT-proBNP levels were associated with an increased risk of HF even among individuals with obesity, despite an inverse association between NT-proBNP and BMI.
This is an important study that corroborates the known inverse association between baseline BMI and NT-proBNP levels. However, the authors draw attention to how despite this inverse relationship, NT-proBNP provides significant prognostic information regarding the risk of developing HF even among individuals with obesity.
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