Abstract 3106: Longitudinal Changes in NT-proBNP Predict New Onset Heart Failure in Community-Dwelling Older Adults: The Cardiovascular Health Study
In patients with heart failure (HF), changes in NTproBNP in response to treatment are strong predictors of outcome. In contrast, it is unknown whether there are dynamic changes in NTproBNP in the general population without HF, and whether these changes confer a change in risk of developing heart failure. We measured NTproBNP on sera collected at baseline and at a follow-up visit after 2 or 3 years in the Cardiovascular Health Study (CHS). Cox regression models were used to measure the effect of change in NTproBNP on risk of new onset HF over 15 years. Patients were categorized according to baseline levels as < or > =190pg/mL, based on an observed increase in risk above this level. A clinically significant change was defined as a change of >25% to a level above or below this cut-point, based on the reported biological variability of NTproBNP. Change in NTproBNP was also considered as a continous measure. Adjustment was made for demographic factors, baseline NTproBNP, co-morbidity (renal function, diabetes, coronary disease) blood pressure, lipids, smoking, and use of beta-blockers and ACE inhibitors Baseline and follow-up NTproBNP were measured in 2,975 (86%) of 3,469 participants who survived without HF and had an in-person study visit at follow-up (age was 74.7 +/− 5.1 years, 15.5% African-American); the prevalence of diabetes, hypertension, and coronary heart disease was 16%, 57%, and 20%. Clinically significant increases in NTproBNP were associated with elevated risk of incident heart failure compared to those with stable levels, while decreases in NTproBNP were associated with reduced risk (Table⇓). Additional adjustment for self-perceived health status did not change the results. As a continuous measure, change in NTproBNP was linearly associated with HF risk (per Ln-fold increment: RR=1.43, p<.001) Long-term changes in NTproBNP are strongly associated with risk of new-onset HF in community-dwelling older adults.