Key result
Elevated NT-proBNP is linked to ~67% higher all-cause mortality in adults without prior CVD.
Why the study?
Prior studies suggesting NT-proBNP has prognostic value in ambulatory adults were primarily conducted in middle-aged and older populations, leaving its association with mortality in the broader general population incompletely characterized.
Does elevated NT-proBNP predict all-cause and cardiovascular mortality in the general US adult population?
Cohort (n=10,645)
Yes
Does elevated NT-proBNP predict all-cause and cardiovascular mortality in the general US adult population?
Effect estimate: HR 1.67 (95% CI 1.39-2.00)
In a representative sample of US adults, elevated NT-proBNP is an independent risk factor for all-cause and cardiovascular mortality, suggesting its potential utility for risk monitoring in the general population.
May support risk stratification in primary prevention; extends evidence to US adults without CVD but leaves clinical adoption open.
Background NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) is strongly associated with mortality in patients with heart failure. Prior studies, primarily in middle‐aged and older populations, have suggested that NT‐proBNP has prognostic value in ambulatory adults. Methods and Results We conducted a prospective cohort analysis of adults, aged ≥20 years, in the nationally representative 1999 to 2004 National Health and Nutrition Examination Survey, to characterize the association of NT‐proBNP with mortality in the general US adult population overall and by age, race and ethnicity, and body mass index. We used Cox regression to characterize associations of NT‐proBNP with all‐cause and cardiovascular disease (CVD) mortality through 2019, adjusting for demographics and cardiovascular risk factors. We included 10 645 individuals (mean age, 45.7 years; 50.8% women; 72.8% White adults; 8.5% with a self‐reported history of CVD). There were 3155 deaths (1009 CVD‐related) over a median 17.3 years of follow‐up. Among individuals without prior CVD, elevated NT‐proBNP (≥75th percentile [81.5 pg/mL] versus <25th percentile [20.5 pg/mL]) was associated with a significantly higher risk of all‐cause (hazard ratio [HR], 1.67 [95% CI, 1.39–2.00]) and CVD mortality (HR, 2.87 [95% CI, 1.61–5.11]). Associations of NT‐proBNP with all‐cause and CVD mortality were generally similar across subgroups defined by age, sex, race and ethnicity, or body mass index (all P interaction >0.05). Conclusions In a representative sample of the US adult population, NT‐proBNP was an important independent risk factor for all‐cause and CVD mortality. NT‐proBNP may be useful for monitoring risk in the general adult population.
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Echouffo‐Tcheugui et al. (2023) conducted a cohort in General adult population (n=10,645). Elevated NT-proBNP (≥75th percentile) vs. Low NT-proBNP (<25th percentile) was evaluated on All-cause mortality (HR 1.67, 95% CI 1.39-2.00). Elevated NT-proBNP (≥81.5 pg/mL) versus low levels (<20.5 pg/mL) was associated with a significantly higher risk of all-cause mortality (HR 1.67; 95% CI 1.39-2.00) in adults without prior CVD.
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