Longitudinal Heart Stress Status Predicts CVD and Mortality in Older Adults

In community-dwelling older adults without prior cardiovascular disease (CVD), new or persistent heart stress (HS)—defined by elevated NT-proBNP concentrations over 3 years—was associated with substantially higher risks of CVD and all-cause mortality, whereas HS remission was associated with risks similar to those of individuals who remained HS-free. In the observational study of 8,454 ASPREE/ASPREE-XT Australians (mean age, 78 years; 52.9% women), HS status was classified according to 3-year changes in NT-proBNP as persistently HS-free, HS remission, incident HS, or sustained HS. Over a median follow-up of 8.0 years, 818 CVD events (nonfatal myocardial infarction, fatal or nonfatal stroke, coronary heart disease death, or heart failure hospitalization) and 1,584 deaths occurred. Compared with participants who remained HS-free, the adjusted absolute risk of total CVD at year 8 was 7.4% higher among those with incident HS and 6.7% higher among those with sustained HS; the adjusted absolute risk of all-cause mortality was 6.1% and 7.5% higher, respectively. Participants whose HS remitted had risks similar to those who remained HS-free. These findings suggest that longitudinal changes in NT-proBNP and resulting HS status may improve risk stratification for CVD and mortality in older adults, although the observational design and predominantly White study population limit generalizability. Source: https://www.acpjournals.org/