Abstract 10215: Characteristics of a Population at High Risk of Heart Failure, and Relationship of NT-proB Natriuretic Peptide with Underlying Risk Factors and Medication: Screen-HF Study
PURPOSE: NT-proB natriuretic peptide (NT-proBNP) is a sensitive marker of ventricular dysfunction. Understanding the relationships between risk factors and NT-proBNP is the first step in developing a tool to interpret NT-proBNP specific to patient characteristics. This may improve the PPV and hence the biomarker's role in heart failure (HF) screening. We sought to investigate the relationship of NT-proBNP to HF risk factors.
METHOD: The SCReening Evaluation of the Evolution of New Heart Failure (SCREEN-HF) study (n=3550), recruited from health fund members, people at high risk for development of HF (>60 years plus >1 HF risk factor), but without a previous HF diagnosis or left ventricular dysfunction. Past medical history, medications, anthropomorphic data and pathology were collected; including NT-proBNP. Participants are currently undergoing echocardiogram assessment and yearly review for incident HF.
RESULTS: The mean age was 70.3 (SD 6.6) years, and 55% were male. Prevalence of HF risk factors were: CAD 24% (95%CI: 22-25%), AF 10% (95%CI: 9-11%), hypertension 83% (95%CI: 82-84%), diabetes 17% (95%CI: 16-18%), and BMI >30 kg/m2 32% (95%CI: 30-33%). Medications use was: ACE or ARB 74% (95%CI: 72-75%), βblocker 24% (95%CI: 23-26%), calcium channel blocker 27% (95%CI: 25-28%), diuretic 34% (95%CI: 32-35%), aspirin or clopidogrel 46% (95%CI: 44-47%), and lipid therapy 54% (95%CI: 52-55%). A multivariate linear regression for log-transformed NT-proBNP estimated fold increases in geometric mean NT-proBNP associated with HF risk factors as follows: age 1.69 increase per decade, female gender 1.36, CAD 1.59, AF 2.84, renal impairment 1.28 per 10ml reduction in eGFR <60 ml/min/1.73m2 (all p<0.001), hypertension 1.13 (p = 0.005), and BMI 0.99 fold decrease (p = 0.03). In a second model there was a 0.92 decrease in NT-proBNP with ACE or ARB use (p=0.02) and 1.91 increase with βblocker use (p<0.001) after adjustment for age and gender.
CONCLUSION: In this high risk population NT-proBNP was associated with HF risk factors and medications. Interpreting NT-proBNP, in this context of patient characteristics, may improve prediction of ventricular dysfunction, reducing the number of echocardiograms required and result in a more cost-effective screening tool.
- © 2011 by American Heart Association, Inc.