Key result
On-treatment NT-proBNP ≤1000 pg/mL linked to ~58% lower risk of HF events or CV death.
Why the study?
Obese patients have lower NT-proBNP levels, and the prognostic implications of achieving NT-proBNP levels ≤1000 pg/mL in obese patients with HF receiving biomarker-guided therapy are not completely known.
Does achieving on-treatment NT-proBNP levels ≤1000 pg/mL reduce the risk of heart failure hospitalization or cardiovascular death in obese and nonobese patients with HFrEF?
Cohort (n=873)
Unblinded
Yes
Does achieving on-treatment NT-proBNP levels ≤1000 pg/mL reduce the risk of heart failure hospitalization or cardiovascular death in obese and nonobese patients with HFrEF?
Achieving on-treatment NT-proBNP levels ≤1000 pg/mL is associated with a significantly lower risk of heart failure hospitalization or cardiovascular death in HFrEF patients, regardless of whether they are obese or nonobese.
May inform risk stratification across obesity in HFrEF; leaves open whether targeting NT-proBNP ≤1000 pg/mL improves outcomes in trials.
Background Obese patients have lower NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) levels. The prognostic implications of achieving NT‐proBNP levels ≤1000 pg/mL in obese patients with heart failure (HF) receiving biomarker‐guided therapy are not completely known. We evaluated the prognostic implications of obesity and having NT‐proBNP levels (≤1000 pg/mL) in the GUIDE‐IT (Guiding Evidence‐Based Therapy Using Biomarker‐Intensified Treatment in HF) trial participants. Methods and Results The risk of adverse cardiovascular events (HF hospitalization or cardiovascular mortality) was assessed using multivariable‐adjusted Cox proportional hazard models based on having NT‐proBNP ≤1000 pg/mL (taken as a time‐varying covariate), stratified by obesity status. The study outcome was also assessed on the basis of the body mass index at baseline. The predictive ability of NT‐proBNP for adverse cardiovascular events was assessed using the likelihood ratio test. Compared with nonobese patients, obese patients were mostly younger, Black race, and more likely to be women. NT‐proBNP levels were 59.0% (95% CI, 39.5%–83.5%) lower among obese individuals. The risk of adverse cardiovascular events was lower in obese (hazard ratio [HR], 0.48; 95% CI, 0.29–0.59) and nonobese (HR, 0.32; 95% CI, 0.19–0.57) patients with HF who had NT‐proBNP levels ≤1000 pg/mL, compared with those who did not. There was no interaction between obesity and having NT‐proBNP ≤1000 pg/mL on the study outcome ( P >0.10). Obese patients had a greater risk of developing adverse cardiovascular events (HR, 1.39; 95% CI, 1.01–1.90) compared with nonobese patients. NT‐proBNP was the strongest predictor of adverse cardiovascular event risk in both obese and nonobese patients. Conclusions On‐treatment NT‐proBNP level ≤1000 pg/mL has favorable prognostic implications, irrespective of obesity status. NT‐proBNP levels were the strongest predictor of cardiovascular events in both obese and nonobese individuals in this trial. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01685840.
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Parcha et al. (2021) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=873). On-treatment NT-proBNP levels ≤1000 pg/mL vs. NT-proBNP levels >1000 pg/mL was evaluated on Adverse cardiovascular events (composite of HF hospitalization and cardiovascular mortality) (HR 0.42, 95% CI 0.29-0.59, p=<0.001). Achieving on-treatment NT-proBNP levels ≤1000 pg/mL was associated with a 58% lower risk of heart failure hospitalization or cardiovascular death (HR 0.42), irrespective of obesity status.
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