Bone morphogenetic protein 10, a novel marker of atrial stress, is associated with incident heart failure in the general population

Objective Bone Morphogenetic Protein 10 (BMP10) is a cardiac-specific, atrial-enriched biomarker. We aimed to examine the association of circulating BMP10 with incident heart failure (HF), and its subtypes. Methods and Results We included 6028 individuals from the Prevention of Renal and Vascular End-stage Disease (PREVEND) community-based cohort (median [Q1-Q3] age: 52 [44-63) years, 51.7% women). Participants were free of HF and had available BMP10 data. Incident HF, HF with preserved ejection fraction (HFpEF), and HF with reduced ejection fraction (HFrEF) were adjudicated. During a median follow-up of 19.1 (14.8-19.8) years, 522 participants (8.7%) developed HF, of which 192 (36.8%) developed HFpEF and 330 (63.2%) developed HFrEF. In Cox-proportional hazards models adjusting for age, sex, relative fat mass, systolic blood pressure, smoking, blood cholesterol, blood glucose, urinary albumin excretion, and estimated glomerular filtration rate (Table 1), a unit increase of BMP10 (ng/ml) was significantly associated with incident HF (hazard ratio [HR]: 1.98; 95% confidence interval [CI]: 1.30–3.04). In secondary analyses, BMP10 was associated with incident HFrEF (HR: 2.34; 95%CI: 1.42–3.84) but not with incident HFpEF (HR:1.38; 95%CI: 0.60–3.16). Associations were strongest during early follow-up and attenuated over time. Conclusions In the general population, BMP10 was associated with the risk of incident HF, particularly in the short term. Secondary analyses suggest that, despite its atrial-enriched biology, BMP10 is more strongly associated with incident HFrEF than HFpEF, consistent with prior findings for cardiac-specific biomarkers.