Natriuretic Peptide Cut Points for Heart Failure Classification in Individuals With and Without Obesity

Area of Science:

• Cardiology
• Biomarkers
• Obesity Medicine

Background:

• The 2022 AHA/ACC/HFSA guidelines use elevated natriuretic peptides (NPs) to define stage B heart failure (HF), identifying high-risk individuals.
• Obesity is known to affect NP levels, potentially impacting the accuracy of this new HF definition.

Purpose of the Study:

• To investigate if a single NP cut point disproportionately up-classifies individuals with obesity to stage B HF compared to normal-weight individuals.
• To assess the impact of obesity on NP levels and their association with future HF risk.

Main Methods:

• Analysis of 32,735 participants from 5 community cohorts, free of prevalent HF.
• Comparison of stage B HF reclassification using 2022 vs. 2013 guidelines, stratified by obesity class.
• Utilized Cox proportional hazards models to examine NP-HF risk association across obesity classes.

Main Results:

• A single NP cut point up-classified fewer individuals with obesity (42-47%) to stage B HF compared to normal-weight individuals (62%).
• Higher NP and body mass index were independently associated with increased HF risk (P<0.0001).
• Optimal NT-proBNP cut points for predicting HF risk were lower in individuals with obesity (80 pg/mL) versus normal weight (109 pg/mL).

Conclusions:

• A uniform NP cut point may lead to under-classification of HF risk in individuals with obesity.
• Tailoring NP cut points based on obesity status could enhance the precision of stage B HF identification and HF risk stratification.