Anthropometric adiposity measures and natriuretic peptides in heart failure screening: population-based evidence from...

Obesity is linked to heart failure, particularly with preserved ejection fraction, but is associated with lower natriuretic peptide levels, potentially leading to underdiagnosis.

To examine the association between adiposity measures-body mass index, waist circumference, and waist-to-height ratio-and N-terminal pro-B-type natriuretic peptide levels, and to determine if lower cut-offs should be used to rule out heart failure in individuals with obesity.

PORTHOS is a 2023 population-based study in Portugal including adults aged 50 years or older. Participants underwent N-terminal pro-B-type natriuretic peptide screening, followed by clinical and echocardiographic assessment in those with levels >= 125 pg/mL, self-reported heart failure, or a 5% random sample with levels <125 pg/mL.

Among 2498 participants, obesity prevalence range from 25% using body mass index ≥30 kg/m² to >70% using waist-to-height ratio ≥0.6. Body mass index showed a strong inverse association with N-terminal pro-B-type natriuretic peptide, with approximately 50 pg/mL lower levels per 5 kg/m² increase. Individuals with obesity and peptide levels < 125 pg/mL had higher odds of heart failure symptoms (odds ratio 1.97, 95% confidence interval 1.15-3.38) and echocardiographic abnormalities (odds ratio 3.63, 95% confidence interval 1.27-10.4) than lean participants with levels >= 125 pg/mL, despite being 9 years younger and having fourfold lower median peptide levels (59 vs 235 pg/mL).

Obesity is associated with lower N-terminal pro-B-type natriuretic peptide levels despite a higher burden of symptoms and structural abnormalities. Fixed cut-offs do not reliably exclude heart failure in individuals with obesity.