Longitudinal Changes in Heart Stress and the Risk for Cardiovascular Disease and Mortality in Older Adults

BACKGROUND: Age-specific elevation in N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations, previously termed "heart stress (HS)," has been associated with adverse cardiovascular disease (CVD) outcomes. Yet, HS status, as defined by longitudinal changes in NT-proBNP concentrations, may improve risk assessment for CVD and mortality in older adults. OBJECTIVE: To evaluate HS status on the basis of 3-year changes in NT-proBNP concentrations with risk for total CVD and all-cause mortality in community-dwelling older adults free of prior CVD. DESIGN: Observational study. SETTING: The ASPREE (ASPirin in Reducing Events in the Elderly) trial and subsequent observational extension (ASPREE-XT). PARTICIPANTS: 8454 participants (mean age, 78.0 years at year 3; 52.9% women) without prior CVD who had NT-proBNP measured at trial enrollment and year 3. MEASUREMENTS: Heart stress status, based on changes in NT-proBNP concentrations from enrollment to year 3, was examined in 4 categories: persistently HS-free, HS remission, incident HS, or sustained HS. The 2 coprimary outcomes were total CVD (nonfatal myocardial infarction, fatal or nonfatal stroke, coronary heart disease death, or heart failure hospitalization) and all-cause mortality. RESULTS: Over a median follow-up of 8.0 years, 818 CVD events and 1584 deaths occurred. At year 8, compared with the persistently HS-free category, the adjusted absolute risks (ARs) for total CVD were increased by 7.4% (95% CI, 4.8% to 10.0%) for incident HS and 6.7% (CI, 4.3% to 9.0%) for sustained HS; adjusted ARs were also increased for all-cause mortality by 6.1% (CI, 3.7% to 8.5%) for incident HS and 7.5% (CI, 5.2% to 9.8%) for sustained HS. The HS remission category had similar adjusted ARs to those of the persistently HS-free group. LIMITATION: Observational design and predominantly White participants. CONCLUSION: Heart stress status based on longitudinal changes in NT-proBNP concentration may improve risk stratification of CVD and mortality. PRIMARY FUNDING SOURCE: None.