May 26, 2023Open Access
View Full PaperNT‐proBNP and All‐Cause and Cardiovascular Mortality in US Adults: A Prospective Cohort Study
Key Result
Elevated NT-proBNP (≥81.5 pg/mL) versus low levels (<20.5 pg/mL) was associated with a significantly higher risk of all-cause mortality (HR 1.67; 95% CI 1.39-2.00) in adults without prior CVD.
Study Design
Type
Cohort (n=10,645)
Multicenter
Yes
Structured PICO
Does elevated NT-proBNP predict all-cause and cardiovascular mortality in the general US adult population?
P
Population
10,645 adults aged ≥20 years from the nationally representative 1999-2004 National Health and Nutrition Examination Survey (mean age 45.7 years, 50.8% women, 72.8% White, 8.5% with self-reported history of CVD)
I
Intervention
Elevated NT-proBNP (≥75th percentile [81.5 pg/mL])
C
Comparator
Lower NT-proBNP (<25th percentile [20.5 pg/mL])
O
Outcome
All-cause and cardiovascular disease (CVD) mortality through 2019hard clinical
In a representative sample of US adults, elevated NT-proBNP is an independent risk factor for all-cause and cardiovascular mortality, suggesting its potential utility for risk monitoring in the general population.
Main Result
Effect estimate: HR 1.67 (95% CI 1.39-2.00)
Abstract
Background NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) is strongly associated with mortality in patients with heart failure. Prior studies, primarily in middle‐aged and older populations, have suggested that NT‐proBNP has prognostic value in ambulatory adults. Methods and Results We conducted a prospective cohort analysis of adults, aged ≥20 years, in the nationally representative 1999 to 2004 National Health and Nutrition Examination Survey, to characterize the association of NT‐proBNP with mortality in the general US adult population overall and by age, race and ethnicity, and body mass index. We used Cox regression to characterize associations of NT‐proBNP with all‐cause and cardiovascular disease (CVD) mortality through 2019, adjusting for demographics and cardiovascular risk factors. We included 10 645 individuals (mean age, 45.7 years; 50.8% women; 72.8% White adults; 8.5% with a self‐reported history of CVD). There were 3155 deaths (1009 CVD‐related) over a median 17.3 years of follow‐up. Among individuals without prior CVD, elevated NT‐proBNP (≥75th percentile 81.5 pg/mL versus 0.05). Conclusions In a representative sample of the US adult population, NT‐proBNP was an important independent risk factor for all‐cause and CVD mortality. NT‐proBNP may be useful for monitoring risk in the general adult population.