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.
  
  
  RESULTS
  We followed up 12 230 ARIC participants free of prior HF at baseline (visit 2, 1990-1992) with BMI ≥18.5 kg/m(2). 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/m(2); 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 <200 pg/mL, the average 10-year HF risk was <5% among normal-weight individuals but >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.
authors.affiliation: From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease(C.E.N., R.S.B.) and Department of General Internal Medicine(M.L., J.C., E.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD(C.E.N., K.M., Y.S., M.L., J.C., E.S.); Division of Cardiology, Mount Sinai School of Medicine, New York, NY(S.K.A.); Division of Atherosclerosis and Vascular Medicine(V.N., C.M.B.) and Section of Cardiology(A.D.), Baylor College of Medicine, Houston, TX; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX(V.N., C.M.B.); and Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston TX(A.D., V.N.). cndumel2@jhmi.edu.
authors.forename: Chiadi E
authors.initials: CE
authors.lastname: Ndumele
authors.affiliation: From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease(C.E.N., R.S.B.) and Department of General Internal Medicine(M.L., J.C., E.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD(C.E.N., K.M., Y.S., M.L., J.C., E.S.); Division of Cardiology, Mount Sinai School of Medicine, New York, NY(S.K.A.); Division of Atherosclerosis and Vascular Medicine(V.N., C.M.B.) and Section of Cardiology(A.D.), Baylor College of Medicine, Houston, TX; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX(V.N., C.M.B.); and Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston TX(A.D., V.N.).
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Matsushita
authors.affiliation: From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease(C.E.N., R.S.B.) and Department of General Internal Medicine(M.L., J.C., E.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD(C.E.N., K.M., Y.S., M.L., J.C., E.S.); Division of Cardiology, Mount Sinai School of Medicine, New York, NY(S.K.A.); Division of Atherosclerosis and Vascular Medicine(V.N., C.M.B.) and Section of Cardiology(A.D.), Baylor College of Medicine, Houston, TX; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX(V.N., C.M.B.); and Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston TX(A.D., V.N.).
authors.forename: Yingying
authors.initials: Y
authors.lastname: Sang
authors.affiliation: From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease(C.E.N., R.S.B.) and Department of General Internal Medicine(M.L., J.C., E.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD(C.E.N., K.M., Y.S., M.L., J.C., E.S.); Division of Cardiology, Mount Sinai School of Medicine, New York, NY(S.K.A.); Division of Atherosclerosis and Vascular Medicine(V.N., C.M.B.) and Section of Cardiology(A.D.), Baylor College of Medicine, Houston, TX; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX(V.N., C.M.B.); and Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston TX(A.D., V.N.).
authors.forename: Mariana
authors.initials: M
authors.lastname: Lazo
authors.affiliation: From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease(C.E.N., R.S.B.) and Department of General Internal Medicine(M.L., J.C., E.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD(C.E.N., K.M., Y.S., M.L., J.C., E.S.); Division of Cardiology, Mount Sinai School of Medicine, New York, NY(S.K.A.); Division of Atherosclerosis and Vascular Medicine(V.N., C.M.B.) and Section of Cardiology(A.D.), Baylor College of Medicine, Houston, TX; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX(V.N., C.M.B.); and Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston TX(A.D., V.N.).
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Agarwal
authors.affiliation: From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease(C.E.N., R.S.B.) and Department of General Internal Medicine(M.L., J.C., E.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD(C.E.N., K.M., Y.S., M.L., J.C., E.S.); Division of Cardiology, Mount Sinai School of Medicine, New York, NY(S.K.A.); Division of Atherosclerosis and Vascular Medicine(V.N., C.M.B.) and Section of Cardiology(A.D.), Baylor College of Medicine, Houston, TX; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX(V.N., C.M.B.); and Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston TX(A.D., V.N.).
authors.forename: Vijay
authors.initials: V
authors.lastname: Nambi
authors.affiliation: From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease(C.E.N., R.S.B.) and Department of General Internal Medicine(M.L., J.C., E.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD(C.E.N., K.M., Y.S., M.L., J.C., E.S.); Division of Cardiology, Mount Sinai School of Medicine, New York, NY(S.K.A.); Division of Atherosclerosis and Vascular Medicine(V.N., C.M.B.) and Section of Cardiology(A.D.), Baylor College of Medicine, Houston, TX; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX(V.N., C.M.B.); and Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston TX(A.D., V.N.).
authors.forename: Anita
authors.initials: A
authors.lastname: Deswal
authors.affiliation: From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease(C.E.N., R.S.B.) and Department of General Internal Medicine(M.L., J.C., E.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD(C.E.N., K.M., Y.S., M.L., J.C., E.S.); Division of Cardiology, Mount Sinai School of Medicine, New York, NY(S.K.A.); Division of Atherosclerosis and Vascular Medicine(V.N., C.M.B.) and Section of Cardiology(A.D.), Baylor College of Medicine, Houston, TX; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX(V.N., C.M.B.); and Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston TX(A.D., V.N.).
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.affiliation: From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease(C.E.N., R.S.B.) and Department of General Internal Medicine(M.L., J.C., E.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD(C.E.N., K.M., Y.S., M.L., J.C., E.S.); Division of Cardiology, Mount Sinai School of Medicine, New York, NY(S.K.A.); Division of Atherosclerosis and Vascular Medicine(V.N., C.M.B.) and Section of Cardiology(A.D.), Baylor College of Medicine, Houston, TX; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX(V.N., C.M.B.); and Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston TX(A.D., V.N.).
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.affiliation: From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease(C.E.N., R.S.B.) and Department of General Internal Medicine(M.L., J.C., E.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD(C.E.N., K.M., Y.S., M.L., J.C., E.S.); Division of Cardiology, Mount Sinai School of Medicine, New York, NY(S.K.A.); Division of Atherosclerosis and Vascular Medicine(V.N., C.M.B.) and Section of Cardiology(A.D.), Baylor College of Medicine, Houston, TX; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX(V.N., C.M.B.); and Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston TX(A.D., V.N.).
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.affiliation: From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease(C.E.N., R.S.B.) and Department of General Internal Medicine(M.L., J.C., E.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD(C.E.N., K.M., Y.S., M.L., J.C., E.S.); Division of Cardiology, Mount Sinai School of Medicine, New York, NY(S.K.A.); Division of Atherosclerosis and Vascular Medicine(V.N., C.M.B.) and Section of Cardiology(A.D.), Baylor College of Medicine, Houston, TX; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX(V.N., C.M.B.); and Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston TX(A.D., V.N.).
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Selvin
mesh_terms: D050197:Atherosclerosis / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009765:Obesity / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D010446:Peptide Fragments / Q000097:blood*; D011446:Prospective Studies; D012111:Residence Characteristics; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: epidemiology; heart failure; natriuretic peptides; obesity; risk assessment