Dynamic Cardiovascular Risk Assessment in Elderly People

Abstract

Abstract. Objectives. This study sought to determine whether serial measurement of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in com-munity-dwelling elderly people would provide additional prognostic information to that from traditional risk factors. Background. Accurate cardiovascular risk stratification is challenging in elderly people. Methods. NT-proBNP was measured at baseline and 2 to 3 years later in 2975 community-dwelling older adults free of heart failure in the longitudinal Cardiovascular Health Study (CHS). This investigation examined the risk of new-onset heart failure (HF) and death from cardiovascular causes associated with baseline NT-proBNP and changes in NT-proBNP levels, adjusting for potential confounders. Results. NT-proBNP levels in the highest quintile (>267.7 pg/mL) were independently associated with greater risks of HF (hazard ratio [HR], 3.05; 95% confidence interval [CI], 2.46–3.78) and cardiovascular death (HR, 3.02; 95% CI, 2.36–3.86) compared with the lowest quintile (<47.5 pg/mL). The inflection point for elevated risk occurred at NT-proBNP 190 pg/mL. Among participants with initially low NT-proBNP (<190 pg/mL), those with a >25% increase on follow-up to >190 pg/mL (21%) were at greater adjusted risk for HF (HR, 2.13; 95% CI, 1.68–2.71) and cardiovascular death (HR, 1.91; 95% CI, 1.43–2.53) compared with those with sustained low levels. Among participants with initially high NT-proBNP, those with a >25% increase (40%) were at higher risk for HF (HR, 2.06; 95% CI, 1.56–2.72) and cardiovascular death (HR, 1.88; 95% CI, 1.37–2.57), whereas those with a >25% decrease to ≤190 pg/mL (15%) were at lower risk for HF (HR, 0.58; 95% CI, 0.36–0.93) and cardiovascular death (HR, 0.57; 95% CI, 0.32–1.01) compared with those with unchanged high values. Conclusions. NT-proBNP levels independently predict HF and cardiovascular death in older adults. NT-proBNP levels frequently change over time, and these fluctuations reflect dynamic changes in cardiovascular risk. deFilippi CR, Christenson RH, Gottdiener JS, et al. Dynamic cardiovascular risk assessment in elderly people. The role of repeated N-terminal pro-B-type natriuretic testing. J Am Coll Cardiol. 2010; 55: 441-450.