Mayo Clinic proceedings · 2026
Associations of Serially Measured NT-proBNP With Incident Heart Failure With Reduced and Preserved Ejection Fraction.
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Kok Thomas F, van Essen Bart J, Weerts Jerremy, Yang Yiqian, Achten Anouk, Gansevoort Ron T, Bakker Stephan J L, van Empel Vanessa, Damman Kevin, Boersma Eric, Kardys Isabella, Voors Adriaan A, de Boer Rudolf A, Suthahar Navin
Аннотация
OBJECTIVE: To evaluate the association between serial N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurements and incident heart failure with reduced versus preserved ejection fraction (HFrEF vs HFpEF) in community-dwelling adults. Given known sex-based differences in HF subtypes, we examined women and men separately.
METHODS: The analysis was conducted using data from the PREVEND (Prevention of Renal and Vascular End-stage Disease) cohort, with a median (Q1-Q3) follow-up of 23.4 (Q1-Q3: 13.4 to 23.8) years. Plasma NT-proBNP levels were measured at three time points: baseline, after a median of 4.2 years, and after 9.3 years. Associations between serial NT-proBNP measurements and incident HF and its subtypes were assessed using joint models.
RESULTS: Among 8486 participants (median age: 48.4 [Q1-Q3: 39.2 to 60.1] years, 50.2% women), 806 (9.5%) developed HF, including 536 with HFrEF (33.4% women) and 270 with HFpEF (57.0% women). In a multivariable model, serial NT-proBNP measurements were strongly associated with incident HF (HR per doubling, 1.90; 95% CI, 1.74 to 2.08), with a stronger association for HFrEF than HFpEF (HRHFrEF, 2.07; 95% CI, 1.87 to 2.31 vs HRHFpEF, 1.48; 95% CI, 1.27 to 1.72; Pdifference<.001). In sex-specific analyses, the differential association of serial NT-proBNP with incident HFrEF vs HFpEF was more pronounced in women (HRHFrEF: 2.76; 95% CI, 2.17 to 3.58 vs HRHFpEF: 1.57; 95% CI, 1.20 to 2.05; Pdifference=.002) than in men (HRHFrEF: 1.90; 95% CI, 1.70 to 2.12 vs HRHFpEF: 1.51; 95% CI, 1.25 to 1.84; Pdifference=.048).
CONCLUSION: Serial NT-proBNP measurements were more strongly associated with incident HFrEF than HFpEF. This stronger association with incident HFrEF was particularly pronounced in women.
METHODS: The analysis was conducted using data from the PREVEND (Prevention of Renal and Vascular End-stage Disease) cohort, with a median (Q1-Q3) follow-up of 23.4 (Q1-Q3: 13.4 to 23.8) years. Plasma NT-proBNP levels were measured at three time points: baseline, after a median of 4.2 years, and after 9.3 years. Associations between serial NT-proBNP measurements and incident HF and its subtypes were assessed using joint models.
RESULTS: Among 8486 participants (median age: 48.4 [Q1-Q3: 39.2 to 60.1] years, 50.2% women), 806 (9.5%) developed HF, including 536 with HFrEF (33.4% women) and 270 with HFpEF (57.0% women). In a multivariable model, serial NT-proBNP measurements were strongly associated with incident HF (HR per doubling, 1.90; 95% CI, 1.74 to 2.08), with a stronger association for HFrEF than HFpEF (HRHFrEF, 2.07; 95% CI, 1.87 to 2.31 vs HRHFpEF, 1.48; 95% CI, 1.27 to 1.72; Pdifference<.001). In sex-specific analyses, the differential association of serial NT-proBNP with incident HFrEF vs HFpEF was more pronounced in women (HRHFrEF: 2.76; 95% CI, 2.17 to 3.58 vs HRHFpEF: 1.57; 95% CI, 1.20 to 2.05; Pdifference=.002) than in men (HRHFrEF: 1.90; 95% CI, 1.70 to 2.12 vs HRHFpEF: 1.51; 95% CI, 1.25 to 1.84; Pdifference=.048).
CONCLUSION: Serial NT-proBNP measurements were more strongly associated with incident HFrEF than HFpEF. This stronger association with incident HFrEF was particularly pronounced in women.