Division of Endocrinology, Diabetes and Metabolism, Department of Medicine Johns Hopkins University Baltimore MD.
Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research Johns Hopkins Bloomberg School of Public Health Baltimore MD.
J Am Heart Assoc. 2023 Jun 6;12(11):e029110. doi: 10.1161/JAHA.122.029110. Epub 2023 May 26.
Background NT-proBNP (N-terminal pro-B-type natriuretic peptide) is strongly associated with mortality in patients with heart failure. Prior studies, primarily in middle-aged and older populations, have suggested that NT-proBNP has prognostic value in ambulatory adults. Methods and Results We conducted a prospective cohort analysis of adults, aged ≥20 years, in the nationally representative 1999 to 2004 National Health and Nutrition Examination Survey, to characterize the association of NT-proBNP with mortality in the general US adult population overall and by age, race and ethnicity, and body mass index. We used Cox regression to characterize associations of NT-proBNP with all-cause and cardiovascular disease (CVD) mortality through 2019, adjusting for demographics and cardiovascular risk factors. We included 10 645 individuals (mean age, 45.7 years; 50.8% women; 72.8% White adults; 8.5% with a self-reported history of CVD). There were 3155 deaths (1009 CVD-related) over a median 17.3 years of follow-up. Among individuals without prior CVD, elevated NT-proBNP (≥75th percentile [81.5 pg/mL] versus <25th percentile [20.5 pg/mL]) was associated with a significantly higher risk of all-cause (hazard ratio [HR], 1.67 [95% CI, 1.39-2.00]) and CVD mortality (HR, 2.87 [95% CI, 1.61-5.11]). Associations of NT-proBNP with all-cause and CVD mortality were generally similar across subgroups defined by age, sex, race and ethnicity, or body mass index (all interaction >0.05). Conclusions In a representative sample of the US adult population, NT-proBNP was an important independent risk factor for all-cause and CVD mortality. NT-proBNP may be useful for monitoring risk in the general adult population.
N 端脑利钠肽前体（NT-proBNP）与心力衰竭患者的死亡率密切相关。先前的研究主要在中老年人中进行，表明 NT-proBNP 对门诊成年人具有预后价值。
我们对全国代表性的 1999 年至 2004 年全国健康和营养调查中的 20 岁及以上成年人进行了前瞻性队列分析，以描述 NT-proBNP 与美国普通成年人群的死亡率之间的关系，以及按年龄、种族和族裔以及体重指数划分的死亡率。我们使用 Cox 回归来描述 NT-proBNP 与全因和心血管疾病（CVD）死亡率的相关性，直至 2019 年，调整了人口统计学和心血管危险因素。我们纳入了 10645 名参与者（平均年龄 45.7 岁；50.8%为女性；72.8%为白人成年人；8.5%有 CVD 病史）。中位随访 17.3 年期间共发生 3155 例死亡（1009 例与 CVD 相关）。在没有先前 CVD 的个体中，升高的 NT-proBNP（≥第 75 百分位[81.5 pg/mL]与<第 25 百分位[20.5 pg/mL]）与全因（危险比[HR]，1.67 [95%CI，1.39-2.00]）和 CVD 死亡率（HR，2.87 [95%CI，1.61-5.11]）的风险显著增加相关。NT-proBNP 与全因和 CVD 死亡率的相关性在按年龄、性别、种族和族裔或体重指数定义的亚组中基本相似（所有交互项>0.05）。
在代表美国成年人群的样本中，NT-proBNP 是全因和 CVD 死亡率的重要独立危险因素。NT-proBNP 可能对监测普通成年人群的风险有用。
