Prevalence, Progression, and Prognosis of Heart Stress in the Community: Implications for Heart Failure Prevention.

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.