Title | N-Terminal Pro-Brain Natriuretic Peptide and Heart Failure Risk Among Individuals With and Without Obesity: The Atherosclerosis Risk in Communities (ARIC) Study. |
Publication Type | Journal Article |
Year of Publication | 2016 |
Authors | Ndumele CE, Matsushita K, Sang Y, Lazo M, Agarwal SK, Nambi V, Deswal A, Blumenthal RS, Ballantyne CM, Coresh JJ |
Secondary Authors | Selvin E |
Journal | Circulation |
Volume | 133 |
Issue | 7 |
Pagination | 631-8 |
Date Published | 2016 Feb 16 |
ISSN | 1524-4539 |
Keywords | Atherosclerosis, Biomarkers, Cohort Studies, Female, Follow-Up Studies, Heart Failure, Humans, Male, Middle Aged, Natriuretic Peptide, Brain, Obesity, Peptide Fragments, Prospective Studies, Residence Characteristics, Risk Factors |
Abstract | BACKGROUND: Obesity is a risk factor for heart failure (HF) but is associated with lower N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. It is unclear whether the prognostic value and implications of NT-proBNP levels for HF risk differ across body mass index (BMI) categories. METHODS AND RESULTS: We followed up 12 230 ARIC participants free of prior HF at baseline (visit 2, 1990-1992) with BMI ≥18.5 kg/m(2). We quantified and compared the relative and absolute risk associations of NT-proBNP with incident HF across BMI categories. There were 1861 HF events during a median 20.6 years of follow-up. Despite increased HF risk in obesity, a weak inverse association was seen between baseline BMI and NT-proBNP levels (r=-0.10). Nevertheless, higher baseline NT-proBNP was associated with increased HF risk in all BMI categories. NT-proBNP improved HF risk prediction overall, even among those with severe obesity (BMI ≥35 kg/m(2); improvement in C statistic, 0.032; 95% confidence interval, 0.011-0.053). However, given the higher HF rates among those with obesity, at each NT-proBNP level, higher BMI was associated with greater absolute HF risk. Indeed, among those with NT-proBNP of 100 to 10% among the severely obese. CONCLUSIONS: Despite its inverse relationship with BMI, NT-proBNP provides significant prognostic information on the risk of developing HF even among individuals with obesity. Given the higher baseline HF risk among persons with obesity, even slight elevations in NT-proBNP may have implications for increased absolute HF risk in this population. |
DOI | 10.1161/CIRCULATIONAHA.115.017298 |
Alternate Journal | Circulation |
PubMed ID | 26746175 |
PubMed Central ID | PMC4758863 |
Grant List | HHSN268201100012C / HL / NHLBI NIH HHS / United States HHSN268201100009I / HL / NHLBI NIH HHS / United States K23 HL122447 / HL / NHLBI NIH HHS / United States K24DK106414 / DK / NIDDK NIH HHS / United States HHSN268201100010C / HL / NHLBI NIH HHS / United States HHSN268201100008C / HL / NHLBI NIH HHS / United States HHSN268201100005G / HL / NHLBI NIH HHS / United States HHSN268201100008I / HL / NHLBI NIH HHS / United States HHSN268201100005C / / PHS HHS / United States R01 DK089174 / DK / NIDDK NIH HHS / United States HHSN268201100007C / HL / NHLBI NIH HHS / United States HHSN268201100009C / / PHS HHS / United States R01DK089174 / DK / NIDDK NIH HHS / United States HHSN268201100011I / HL / NHLBI NIH HHS / United States HHSN268201100011C / HL / NHLBI NIH HHS / United States HHSN268201100010C / / PHS HHS / United States HHSN268201100006C / HL / NHLBI NIH HHS / United States HHSN268201100008C / / PHS HHS / United States HHSN268201100012C / / PHS HHS / United States HHSN268201100005I / HL / NHLBI NIH HHS / United States K24 DK106414 / DK / NIDDK NIH HHS / United States HHSN268201100007C / / PHS HHS / United States HHSN268201100009C / HL / NHLBI NIH HHS / United States HHSN268201100011C / / PHS HHS / United States HHSN268201100005C / HL / NHLBI NIH HHS / United States HHSN268201100007I / HL / NHLBI NIH HHS / United States HHSN268201100006C / / PHS HHS / United States K23HL12247 / HL / NHLBI NIH HHS / United States |