N-terminal pro-brain natriuretic peptide and heart failure risk among individuals with and without obesity

The Atherosclerosis Risk in Communities (ARIC) study

Chiadi Ericson Ndumele, Kunihiro Matsushita, Yingying Sang, Mariana Lazo-Elizondo, Sunil K. Agarwal, Vijay Nambi, Anita Deswal, Roger S Blumenthal, Christie M. Ballantyne, Josef Coresh, Elizabeth Selvin

Research output: Contribution to journalArticle

Abstract

Background - Obesity is a risk factor for heart failure (HF) but is associated with lower N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. It is unclear whether the prognostic value and implications of NT-proBNP levels for HF risk differ across body mass index (BMI) categories. Methods and Results - We followed up 12 230 ARIC participants free of prior HF at baseline (visit 2, 1990-1992) with BMI ≥18.5 kg/m2. We quantified and compared the relative and absolute risk associations of NT-proBNP with incident HF across BMI categories. There were 1861 HF events during a median 20.6 years of follow-up. Despite increased HF risk in obesity, a weak inverse association was seen between baseline BMI and NT-proBNP levels (r=-0.10). Nevertheless, higher baseline NT-proBNP was associated with increased HF risk in all BMI categories. NT-proBNP improved HF risk prediction overall, even among those with severe obesity (BMI ≥35 kg/m2; improvement in C statistic, 0.032; 95% confidence interval, 0.011-0.053). However, given the higher HF rates among those with obesity, at each NT-proBNP level, higher BMI was associated with greater absolute HF risk. Indeed, among those with NT-proBNP of 100 to 10% among the severely obese. Conclusions - Despite its inverse relationship with BMI, NT-proBNP provides significant prognostic information on the risk of developing HF even among individuals with obesity. Given the higher baseline HF risk among persons with obesity, even slight elevations in NT-proBNP may have implications for increased absolute HF risk in this population.

Original languageEnglish (US)
Pages (from-to)631-638
Number of pages8
JournalCirculation
Volume133
Issue number7
DOIs
StatePublished - Feb 16 2016

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Brain Natriuretic Peptide
Atherosclerosis
Heart Failure
Obesity
Body Mass Index
Morbid Obesity
Heart Rate

Keywords

  • epidemiology
  • heart failure
  • natriuretic peptides
  • obesity
  • risk assessment

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

@article{378e814dccd24697a4f32156c8908d3c,
title = "N-terminal pro-brain natriuretic peptide and heart failure risk among individuals with and without obesity: The Atherosclerosis Risk in Communities (ARIC) study",
abstract = "Background - Obesity is a risk factor for heart failure (HF) but is associated with lower N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. It is unclear whether the prognostic value and implications of NT-proBNP levels for HF risk differ across body mass index (BMI) categories. Methods and Results - We followed up 12 230 ARIC participants free of prior HF at baseline (visit 2, 1990-1992) with BMI ≥18.5 kg/m2. We quantified and compared the relative and absolute risk associations of NT-proBNP with incident HF across BMI categories. There were 1861 HF events during a median 20.6 years of follow-up. Despite increased HF risk in obesity, a weak inverse association was seen between baseline BMI and NT-proBNP levels (r=-0.10). Nevertheless, higher baseline NT-proBNP was associated with increased HF risk in all BMI categories. NT-proBNP improved HF risk prediction overall, even among those with severe obesity (BMI ≥35 kg/m2; improvement in C statistic, 0.032; 95{\%} confidence interval, 0.011-0.053). However, given the higher HF rates among those with obesity, at each NT-proBNP level, higher BMI was associated with greater absolute HF risk. Indeed, among those with NT-proBNP of 100 to 10{\%} among the severely obese. Conclusions - Despite its inverse relationship with BMI, NT-proBNP provides significant prognostic information on the risk of developing HF even among individuals with obesity. Given the higher baseline HF risk among persons with obesity, even slight elevations in NT-proBNP may have implications for increased absolute HF risk in this population.",
keywords = "epidemiology, heart failure, natriuretic peptides, obesity, risk assessment",
author = "Ndumele, {Chiadi Ericson} and Kunihiro Matsushita and Yingying Sang and Mariana Lazo-Elizondo and Agarwal, {Sunil K.} and Vijay Nambi and Anita Deswal and Blumenthal, {Roger S} and Ballantyne, {Christie M.} and Josef Coresh and Elizabeth Selvin",
year = "2016",
month = "2",
day = "16",
doi = "10.1161/CIRCULATIONAHA.115.017298",
language = "English (US)",
volume = "133",
pages = "631--638",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "7",

}

TY - JOUR

T1 - N-terminal pro-brain natriuretic peptide and heart failure risk among individuals with and without obesity

T2 - The Atherosclerosis Risk in Communities (ARIC) study

AU - Ndumele, Chiadi Ericson

AU - Matsushita, Kunihiro

AU - Sang, Yingying

AU - Lazo-Elizondo, Mariana

AU - Agarwal, Sunil K.

AU - Nambi, Vijay

AU - Deswal, Anita

AU - Blumenthal, Roger S

AU - Ballantyne, Christie M.

AU - Coresh, Josef

AU - Selvin, Elizabeth

PY - 2016/2/16

Y1 - 2016/2/16

N2 - Background - Obesity is a risk factor for heart failure (HF) but is associated with lower N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. It is unclear whether the prognostic value and implications of NT-proBNP levels for HF risk differ across body mass index (BMI) categories. Methods and Results - We followed up 12 230 ARIC participants free of prior HF at baseline (visit 2, 1990-1992) with BMI ≥18.5 kg/m2. We quantified and compared the relative and absolute risk associations of NT-proBNP with incident HF across BMI categories. There were 1861 HF events during a median 20.6 years of follow-up. Despite increased HF risk in obesity, a weak inverse association was seen between baseline BMI and NT-proBNP levels (r=-0.10). Nevertheless, higher baseline NT-proBNP was associated with increased HF risk in all BMI categories. NT-proBNP improved HF risk prediction overall, even among those with severe obesity (BMI ≥35 kg/m2; improvement in C statistic, 0.032; 95% confidence interval, 0.011-0.053). However, given the higher HF rates among those with obesity, at each NT-proBNP level, higher BMI was associated with greater absolute HF risk. Indeed, among those with NT-proBNP of 100 to 10% among the severely obese. Conclusions - Despite its inverse relationship with BMI, NT-proBNP provides significant prognostic information on the risk of developing HF even among individuals with obesity. Given the higher baseline HF risk among persons with obesity, even slight elevations in NT-proBNP may have implications for increased absolute HF risk in this population.

AB - Background - Obesity is a risk factor for heart failure (HF) but is associated with lower N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. It is unclear whether the prognostic value and implications of NT-proBNP levels for HF risk differ across body mass index (BMI) categories. Methods and Results - We followed up 12 230 ARIC participants free of prior HF at baseline (visit 2, 1990-1992) with BMI ≥18.5 kg/m2. We quantified and compared the relative and absolute risk associations of NT-proBNP with incident HF across BMI categories. There were 1861 HF events during a median 20.6 years of follow-up. Despite increased HF risk in obesity, a weak inverse association was seen between baseline BMI and NT-proBNP levels (r=-0.10). Nevertheless, higher baseline NT-proBNP was associated with increased HF risk in all BMI categories. NT-proBNP improved HF risk prediction overall, even among those with severe obesity (BMI ≥35 kg/m2; improvement in C statistic, 0.032; 95% confidence interval, 0.011-0.053). However, given the higher HF rates among those with obesity, at each NT-proBNP level, higher BMI was associated with greater absolute HF risk. Indeed, among those with NT-proBNP of 100 to 10% among the severely obese. Conclusions - Despite its inverse relationship with BMI, NT-proBNP provides significant prognostic information on the risk of developing HF even among individuals with obesity. Given the higher baseline HF risk among persons with obesity, even slight elevations in NT-proBNP may have implications for increased absolute HF risk in this population.

KW - epidemiology

KW - heart failure

KW - natriuretic peptides

KW - obesity

KW - risk assessment

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U2 - 10.1161/CIRCULATIONAHA.115.017298

DO - 10.1161/CIRCULATIONAHA.115.017298

M3 - Article

VL - 133

SP - 631

EP - 638

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 7

ER -