Modification of the Association of B-Type Natriuretic Peptides With Mortality and Hospitalization Outcomes by Sex

Figures

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  Figure 1. Risk of All-Cause Mortality by NP Concentration, Stratified by Sex (A) Adjusted 1-year risk of all-cause mortality by BNP concentration, stratified by sex. Probability of 1-year all-cause mortality was higher in males (blue line, top) than females (red line, bottom). 95% CIs are plotted but are too narrow to be visible on figure. The sex-by-BNP interaction for the hazard of all-cause death was statistically significant (P = 0.002). (B) Adjusted 1-year risk of all-cause mortality by NT-proBNP concentration, stratified by sex. Probability of 1-year all-cause mortality was higher in males (blue line, top) than females (red line, bottom). 95% CIs are plotted but are too narrow to be visible on figure. The sex-by-NT-proBNP interaction for the hazard of all-cause death was statistically significant (P = 0.025). BNP = B-type natriuretic peptide; NT-proBNP = N-terminal pro-B-type natriuretic peptide.

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  Figure 2. Risk of CV Death by NP Concentration, Stratified by Sex (A) Adjusted 1-year risk of cardiovascular death by BNP concentration, stratified by sex. The adjusted cumulative incidence of cardiovascular death was comparable in males (blue line) and females (red line), with no sex-by-BNP interaction for cardiovascular death (P = 0.53). 95% CIs are plotted but are too narrow to be visible on figure. (B) Adjusted 1-year risk of cardiovascular death by NT-proBNP concentration, stratified by sex. The adjusted cumulative incidence of cardiovascular death was comparable in males (blue line) and females (red line), with no sex-by-NT-proBNP interaction for cardiovascular death (P = 0.97). 95% CIs are plotted, but are too narrow to be visible on figure. CV = cardiovascular; other abbreviations as in Figure 1.

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  Figure 3. Risk of CV Hospitalization by NP Concentration, Stratified by Sex (A) Adjusted 1-year risk of cardiovascular hospitalization by BNP concentration, stratified by sex. The adjusted cumulative incidence of cardiovascular hospitalization for males (blue line) and females (red line) exhibited a significant sex-by-BNP interaction (P < 0.001). 95% CIs are plotted, but are too narrow to be visible on figure. At high BNP levels, risk of cardiovascular hospitalization was higher in females than males. (B) Adjusted 1-year risk of cardiovascular hospitalization by NT-proBNP concentration, stratified by sex. The adjusted cumulative incidence of cardiovascular hospitalization for males (blue line) and females (red line) exhibited a trend toward a sex-by-BNP interaction (P = 0.062). 95% CIs are plotted, but are too narrow to be visible on figure. Risk of cardiovascular hospitalization was higher in males than females. Abbreviations as in Figures 1 and 2.

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  Figure 4. Risk of Heart Failure Hospitalization by NP Concentration, Stratified by Sex (A) Adjusted 1-year risk of heart failure hospitalization by BNP concentration, stratified by sex. Sex-by-BNP interaction for heart failure hospitalization was not significant (P = 0.68). 95% CIs are plotted, but are too narrow to be visible on figure. (B) Adjusted 1-year risk of heart failure hospitalization by NT-proBNP concentration, stratified by sex. Sex-by-NT-proBNP interaction for heart failure hospitalization was not significant (P = 0.20). 95% CIs are plotted, but are too narrow to be visible on figure. HF = heart failure; other abbreviations as in Figure 1.

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  Central Illustration. Sex-Based Differences in the Prognostic Value of B-Type Natriuretic Peptides Adjusted 1-year risk of all-cause mortality by B-type natriuretic peptide (BNP, left) and N-terminal pro-BNP (NT-proBNP, right) concentrations demonstrates a sex-based difference, with higher mortality risk observed in males compared to females at any given peptide level. Significant interactions by sex were noted for both BNP (P = 0.002) and NT-proBNP (P = 0.03), indicating that sex modifies the association between natriuretic peptide levels and mortality. 95% CIs are plotted but are too narrow to be visible on figure. These findings demonstrate the importance of integrating sex-specific interpretation into heart failure risk prediction models that incorporate natriuretic peptide biomarkers.