Research led by Monash University shows that high levels of N-terminal pro–B-type natriuretic peptide (NT-proBNP) in the blood of older adults are linked to higher cardiovascular disease risk and all-cause mortality.
As reported in the Annals of Internal Medicine, the researchers found that people above an age-specific NT-proBNP threshold had a cardiovascular disease risk between 15.5% and 16.5% versus 9.2% in those with normal levels of the biomarker.
Similarly, those with higher levels of NT-proBNP had a 21–23% chance of dying of any cause during the study period versus 15.2% in those with normal levels.
“The global population is aging rapidly, with 761 million persons aged 65 years or older in 2021, which is projected to double to 1.6 billion by 2050. This demographic shift is expected to increase the burden of cardiovascular disease, the leading cause of morbidity and mortality in older adults,” the authors wrote.
“As persons age, conventional risk prediction tools become less reliable, in part because they often do not capture the complex interplay of physiologic aging, multimorbidity, and subclinical cardiac dysfunction in older adults. This has increased interest in cardiac biomarkers for risk stratification in the primary prevention setting.”
Higher NT-proBNP can signal cardiac strain, and it is widely used to support diagnosis or rule-out assessment of heart failure in certain clinical settings. It is influenced by a number of factors, including age, so the researchers calculated age-specific thresholds for their study of 150 ng/L or higher for people in the 70–74 years age group and 300 ng/L or higher for those aged 75 years or older.
This study followed 8,454 initially cardiovascular-disease-free adults in Australia, with an average age of 78. Researchers measured NT-proBNP at enrollment and again three years later. They then tracked heart attacks, strokes, and heart-failure admissions as a combined cardiovascular disease outcome, as well as deaths from any cause for around eight more years.
People with either incident or sustained high levels of NT-proBNP had both higher levels of cardiovascular disease risk and were more likely to die during the follow-up period. The most striking difference was in heart-failure hospitalization. Adjusted eight-year risk was 1.3% for people persistently below the threshold, 4.8% for those with newly elevated heart stress, and 5.8% for those with sustained elevation.
Notably, participants whose initially raised NT-proBNP fell below the age-specific threshold by year 3 had normalized levels of cardiovascular risk and mortality, although the researchers cautioned, “due to our observational design, residual confounding remains a concern and causality cannot be inferred.”
They concluded: “Future studies should determine whether heart stress status based on serial values of NT-proBNP can inform care to reduce cardiovascular disease and mortality risk in an older adult population.”
