Predictive Value of Serum N‐Terminal pro‐B‐Type Natriuretic Peptide and Troponin T for Incident Heart Failure: A Meta‐Analysis of 9 International Cohorts

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  Figure 1. Adjusted association of (A) age and (B) estimated glomerular filtration rate with NT‐proBNP across cohorts. Dotted lines represent ASCVD, solid lines represent no ASCVD. A, Adjusted to male sex, SBP 130, BMI 25, no diabetes, no smoking, eGFR 60, ACR 30. B, Adjusted at age 55, male sex, SBP 130, BMI 25, no diabetes, no smoking, ACR 30. Regression model of log NT‐proBNP within each cohort includes age, sex, SBP, diabetes, current smoking status, BMI, eGFR, antihypertensive medication use, log‐urine albumin‐to‐creatinine ratio, ASCVD, and the interaction between ASCVD and age, as well as ASCVD and the 2 eGFR spline terms within each cohort. All associations between age and NT‐proBNP were significant with P<0.001 except for ULSAM, which was P=0.017. All associations between eGFR <60 and NT‐proBNP were significant with P≤0.001 except for DHS, which was P=0.72. The presence of ASCVD was also associated with NT‐proBNP and significant at P≤0.002 except for CHS, which was P=0.74, CRIC which was P=0.42, GCKD, which was P=0.35 and ULSAM, which was P=0.046. MESA study was free of ASCVD. ACR indicates urine albumin‐to‐creatinine ratio; ARIC, Atherosclerosis Risk in Communities Study; ASCVD,…

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  Figure 2. Adjusted associations of (A) 2‐fold higher NT‐proBNP, (B) NT‐proBNP >125 pg/mL, (C) 2‐fold higher hsTnT, and (D) hsTnT ≥10 ng/L for women and 15 ng/L for men with incident heart failure across cohorts. Categorical reference for NT‐proBNP is NT‐proBNP <125 pg/mL; reference for hsTnT is low (<10 ng/L for women and <15 ng/L for men). Hazard ratios for undetectable hsTnT in Table S1. Models adjusted for age, sex, SBP splines, diabetes, current smoking status, BMI splines, eGFR splines, antihypertensive medication use, log‐ACR, and the interaction terms of antihypertensive medication with SBP >110 mm Hg, age with SBP >110 mm Hg, age with diabetes status, age with current smoking status, age with eGFR <60 mL/min/1.73 m2, consistent with the Predicting Risk of Cardiovascular Disease Events equations, as well as ASCVD, age with ASCVD, and ASCVD with SBP >110 mm Hg. ACR indicates urine albumin‐to‐creatinine ratio; ARIC, Atherosclerosis Risk in Communities Study; ASCVD, atherosclerotic cardiovascular disease; BMI, body mass index; CHS, Cardiovascular Health Study; CRIC, Chronic Renal Insufficiency Cohort; DHS, Dallas Heart Study; eGFR, estimated glomerular filtration rate; GCKD, German…

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  Figure 3. Predicted 10‐year absolute risk of incident heart failure by (A) NT‐proBNP levels and (B) hsTnT categories across eGFR categories. To demonstrate the differences in absolute risk of incident HF across cohorts according to different risk characteristics, we estimated 10‐year predicted risk of HF in each cohort using a cause‐specific model of HF accounting for the competing events of mortality. Adjusted to age 55, male sex, SBP 130, BMI 25, no smoking, urine albumin‐to‐creatinine ratio 30. Dots represent the 8 different cohorts (Uppsala Longitudinal Study of Adult Men not included because the age range is 70–73 years). Not detectable, low (<10 ng/L in women or <15 ng/L in men) and high (≥10 ng/L in women or ≥15 ng/L in men). ASCVD indicates atherosclerotic cardiovascular disease; BMI, body mass index; eGFR, estimated glomerular filtration rate; HF, heart failure; hsTNT, high sensitivity troponin T; ND, not detectable; and NT‐proBNP, N‐terminal pro‐brain natriuretic peptide.