Journal of cardiac failure · 2026
Prevalence, Progression, and Prognosis of Heart Stress in the Community: Implications for Heart Failure Prevention.
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Cai Anping, Liu Lin, Feng Yingqing, Zhou Yingling, Li Liwen, Bozkurt Biykem, Januzzi James L, Lam Carolyn S P, Fonarow Gregg C, Pandey Ambarish, Zhou Zhen, Cheng Yunjiu, Bayes-Genis Antoni
Аннотация
BACKGROUND: Early identification of individuals with pre-heart failure (pre-HF) is essential for preventing heart failure (HF) development. Heart stress, defined by age-specific elevations in N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations among individuals who are asymptomatic, has been proposed as an emerging pre-HF concept. Its prevalence, progression, and prognostic implications in community populations remain unclear.
METHODS: We analyzed 10,977 participants from the Atherosclerosis Risk in Communities study and validated the findings in 4825 participants from the Multi-Ethnic Study of Atherosclerosis study. All participants were free of cardiovascular disease at baseline and had NT-proBNP measurements. Heart stress was defined as NT-proBNP ≥75 pg/mL (<50 years), ≥150 pg/mL (50-74 years), or ≥300 pg/mL (≥75 years). Outcomes included all-cause death and the first hospitalization for heart failure event.
RESULTS: In the Atherosclerosis Risk in Communities, 12.1% had prevalent heart stress and 12.3% developed incident heart stress over a 6-year interval. Both prevalent and incident heart stress were associated with greater risks of all-cause death (adjusted hazard ratio, 1.58 [95% confidence interval, 1.45-1.73] and 1.68 [1.52-1.86]) and hospitalization for HF (adjusted hazard ratio, 1.77 [1.55-2.02] and 2.23 [1.94-2.56]). Persistent heart stress conferred the greatest risk, whereas heart stress remission was associated with a lower mortality risk. In the Multi-Ethnic Study of Atherosclerosis, 13.0% had prevalent heart stress and 7.8% developed incident heart stress over a 4-year interval, with consistent associations with adverse outcomes.
CONCLUSIONS: Heart stress is common, dynamic, and significantly associated with adverse outcomes in community populations. Future studies should investigate whether mitigating heart stress can prevent HF development.
METHODS: We analyzed 10,977 participants from the Atherosclerosis Risk in Communities study and validated the findings in 4825 participants from the Multi-Ethnic Study of Atherosclerosis study. All participants were free of cardiovascular disease at baseline and had NT-proBNP measurements. Heart stress was defined as NT-proBNP ≥75 pg/mL (<50 years), ≥150 pg/mL (50-74 years), or ≥300 pg/mL (≥75 years). Outcomes included all-cause death and the first hospitalization for heart failure event.
RESULTS: In the Atherosclerosis Risk in Communities, 12.1% had prevalent heart stress and 12.3% developed incident heart stress over a 6-year interval. Both prevalent and incident heart stress were associated with greater risks of all-cause death (adjusted hazard ratio, 1.58 [95% confidence interval, 1.45-1.73] and 1.68 [1.52-1.86]) and hospitalization for HF (adjusted hazard ratio, 1.77 [1.55-2.02] and 2.23 [1.94-2.56]). Persistent heart stress conferred the greatest risk, whereas heart stress remission was associated with a lower mortality risk. In the Multi-Ethnic Study of Atherosclerosis, 13.0% had prevalent heart stress and 7.8% developed incident heart stress over a 4-year interval, with consistent associations with adverse outcomes.
CONCLUSIONS: Heart stress is common, dynamic, and significantly associated with adverse outcomes in community populations. Future studies should investigate whether mitigating heart stress can prevent HF development.