03168nas a2200349 4500008004100000022001400041245013400055210006900189260001600258300001100274490000700285520214700292653000902439653001502448653001102463653001802474653001102492653000902503653003102512653002202543653001402565653002402579653002002603653001702623653001802640100003002658700002702688700002402715700001902739700002402758856003602782 2010 eng d a1558-359700aDynamic cardiovascular risk assessment in elderly people. The role of repeated N-terminal pro-B-type natriuretic peptide testing.0 aDynamic cardiovascular risk assessment in elderly people The rol c2010 Feb 02 a441-500 v553 a

OBJECTIVES: This study sought to determine whether serial measurement of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in community-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 2,975 community-dwelling older adults free of heart failure in the longitudinal CHS (Cardiovascular Health Study). 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 to 3.78) and cardiovascular death (HR: 3.02; 95% CI: 2.36 to 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 who developed a >25% increase on follow-up to >190 pg/ml (21%) were at greater adjusted risk of HF (HR: 2.13; 95% CI: 1.68 to 2.71) and cardiovascular death (HR: 1.91; 95% CI: 1.43 to 2.53) compared with those with sustained low levels. Among participants with initially high NT-proBNP, those who developed a >25% increase (40%) were at higher risk of HF (HR: 2.06; 95% CI: 1.56 to 2.72) and cardiovascular death (HR: 1.88; 95% CI: 1.37 to 2.57), whereas those who developed a >25% decrease to

CONCLUSIONS: NT-proBNP levels independently predict heart failure and cardiovascular death in older adults. NT-proBNP levels frequently change over time, and these fluctuations reflect dynamic changes in cardiovascular risk.

10aAged10aBiomarkers10aFemale10aHeart Failure10aHumans10aMale10aNatriuretic Peptide, Brain10aPeptide Fragments10aPrognosis10aProspective Studies10aRisk Assessment10aRisk Factors10aUnited States1 adeFilippi, Christopher, R1 aChristenson, Robert, H1 aGottdiener, John, S1 aKop, Willem, J1 aSeliger, Stephen, L uhttps://chs-nhlbi.org/node/1164