Dynamic cardiovascular risk assessment in elderly people

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. © 2010 Wiley Periodicals, Inc.