- Heart disease is the leading cause of death, with one person in the United States dying from the condition every 34 seconds.
- A recent study found that elevated levels of N-terminal pro–B-type natriuretic peptide (NT-proBNP) may indicate increased risk of cardiovascular events and mortality in older adults without prior heart disease.
- However, elevated NT-proBNP levels may also result from factors such as aging, kidney disease, or atrial fibrillation.
- Experts suggest that the blood test could eventually have a role in routine cardiovascular risk assessment, though there are current limitations.
Heart disease is the leading cause of death in the United States. One person dies from heart disease every 34 seconds, according to the Centers for Disease Control and Prevention (CDC).
Screenings to monitor heart health can help assess heart disease risk. The American Heart Association (AHA) notes blood pressure, cholesterol, body weight, and blood glucose as some of the key screening tests for cardiovascular health.
While more research is necessary, this means that NT-proBNP tests could have the potential to highlight cardiovascular risk and help support earlier intervention.
The study focused on 8,454 participants with a mean age of 78 years at year three of the study. The individuals did not have prior cardiovascular disease.
Researchers measured their NT-proBNP levels at the start of the trial and after three years. As the researchers explain, a NT-proBNP blood test may detect heart stress in asymptomatic people if levels are elevated.
After 3 years, 10.6% of participants had incident heart stress, meaning that they didn’t have heart stress at baseline but did have it at year three.
Another 15.1% had sustained heart stress, defined as having heart stress at both baseline and year three. Both of these groups were more likely to experience cardiovascular events and mortality.
After a follow-up of eight years, the adjusted absolute risk for cardiovascular disease was 16.5% among the incident heart stress group and 15.8% among the sustained heart stress group.
Cardiologist Karishma Patwa, MD, with Manhattan Cardiology in NYC, spoke with Medical News Today about these findings.
“These findings suggest that cardiovascular risk may be dynamic and that a previously elevated NT-proBNP level does not necessarily indicate permanently increased risk,” said Patwa, who was not involved in the study.
“That being said, the study does not show that lowering NT-proBNP itself reduces overall cardiovascular risk and mortality, so it should be viewed as a promising prognostic finding rather than a treatment target,” she added.
Kaustubh Dabhadkar, MD, MPH, FACC, board-certified preventive cardiologist at Novant Health and medical advisor to Veevo Health said in an interview with MNT that “[h]eart failure is a clinical diagnosis and NT-proBNP is only one of the indicators. Heart failure indicates inability of the heart to meet the physiologic demands of the body.”
Dabhadkar, who was not involved in the study, added, “In absence of the symptoms or signs that suggest the heart is struggling to meet demands of the body, an elevated NT-proBNP may not be meaningful.”
In the study, 98% of participants were white. This means the sample size does not provide sufficient demographic diversity to determine whether testing for elevated NT-proBNP is beneficial across all groups.
Additionally, “[a]n elevated NT-proBNP indicates increased cardiac stress but does not mean that someone is in heart failure. NT-proBNP can also be elevated due to aging, kidney disease, atrial fibrillation, and other conditions,” explained Patwa.
“It can also be falsely low in obesity and with certain medications. The results should be interpreted alongside other clinical context and testing,” she added.
He explained, “I see elderly patients who occasionally have NT-proBNP checked for an unrelated cause. They may have mildly elevated levels without any clinical signs or symptoms of heart failure.”
He added, “With the abundance of online information that draws a direct connection between elevated NT-proBNP levels and heart failure, a lot of these patients come to my clinic with a concern about failing hearts.”
The study findings are promising.
“Eventually NT-proBNP could have a role in routine cardiovascular risk assessment because this study suggests that changes over time may be prognostic,” explained Patwa.
However, she added, “there is not yet enough evidence to recommend screening because we do not know whether screening and subsequent interventions will actually improve outcomes.”
Patwa also explained that “[c]linicals should look for symptoms and clinical context, including other potential causes of the elevation like kidney disease and atrial fibrillation. Depending on the circumstances, further evaluation may include an ECG and an echocardiogram to determine whether there is underlying structural or functional heart disease.”
However, regarding implementing NT-proBNP tests in routine screening today, Dabhadkar explained, “We don’t have enough evidence to support that approach. Mildly elevated NT-proBNP levels without clinical signs of heart failure may not be meaningful from a cardiac standpoint.”
He added, “Also, we use different cut-offs based on age. […] A test is useful only if it changes the course of action. Even with mildly elevated NT-proBNP but no other clinical concerns, it won’t change management.”
Dabhadkar also explained that “[t]here are some situations where regular NT-proBNP testing is useful for early diagnosis of changes in the heart’s condition. In a patient receiving chemotherapy [that] may affect the heart, early diagnosis of changes in strain on the heart allows changing chemotherapy before irreversible heart damage.”
If a blood test does indicate elevated NT-proBNP levels in an older person, additional tests are necessary. Dabhadkar recommended the following:
“The first step is detailed history to understand the functional levels of the person and any recent changes in activity tolerance. Physical examination helps with diagnosing conditions that may indicate that the heart is struggling to meet the demands of the body. Early signs include leg swelling, abdominal swelling and elevated fluid levels as indicated elevated CVP.”
He added, “An echocardiogram is necessary to confirm appropriate pumping function of the heart and rule out any issues with the heart valves.”
