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Prevalence, Progression, and Prognosis of Heart Stress in the Community: Implications for Heart Failure Prevention
Anping Cai1, Lin Liu2, Yinqing Feng1
1Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
Insights
Heart stress, indicated by elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP), is common in the community. This condition significantly increases the risk of death and heart failure hospitalization.
Area of Science:
- Cardiology
- Preventive Medicine
- Biomarker Research
Background:
- Early identification of pre-heart failure (pre-HF) is crucial for preventing heart failure (HF).
- Heart stress, defined by elevated NT-proBNP in asymptomatic individuals, is an emerging pre-HF concept.
- The prevalence, progression, and prognostic significance of heart stress in community settings are not well understood.
Purpose of the Study:
- To investigate the prevalence, incidence, and prognostic implications of heart stress in large, diverse community populations.
- To determine the association between heart stress and adverse cardiovascular outcomes, including all-cause death and heart failure hospitalization (HHF).
- To explore the dynamic nature of heart stress, including persistence and remission, and their impact on outcomes.
Main Methods:
- Analysis of 10,977 participants from the Atherosclerosis Risk in Communities (ARIC) study, with validation in 4,825 from the Multi-Ethnic Study of Atherosclerosis (MESA) study.
- Participants were free of cardiovascular disease at baseline and underwent NT-proBNP measurements.
- Heart stress defined by age-specific NT-proBNP thresholds (≥75 pg/mL [<50 yrs], ≥150 pg/mL [50-74 yrs], ≥300 pg/mL [≥75 yrs]); outcomes were all-cause death and HHF.
Main Results:
- Prevalent heart stress was observed in 12.1% (ARIC) and 13.0% (MESA); incident heart stress occurred in 12.3% (ARIC) and 7.8% (MESA) over respective follow-up periods.
- Both prevalent and incident heart stress were significantly associated with increased risks of all-cause death (HRs 1.58-1.68) and HHF (HRs 1.77-2.23).
- Persistent heart stress showed the highest risk, while remission was linked to reduced mortality risk, indicating a dynamic relationship.
Conclusions:
- Heart stress is a common and dynamic condition in community populations.
- Heart stress is significantly associated with adverse outcomes, including mortality and heart failure hospitalization.
- Further research is warranted to explore interventions aimed at mitigating heart stress to prevent HF development.
Background:
Early identification of individuals with pre-heart failure (pre-HF) is essential for preventing heart failure (HF) development. Heart stress, defined by age-specific elevations in N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations among individuals who are asymptomatic, has been proposed as an emerging pre-HF concept. Its prevalence, progression, and prognostic implications in community populations remain unclear.
Methods:
We analyzed 10,977 participants from the Atherosclerosis Risk in Communities study and validated the findings in 4825 participants from the Multi-Ethnic Study of Atherosclerosis study. All participants were free of cardiovascular disease at baseline and had NT-proBNP measurements. Heart stress was defined as NT-proBNP ≥75 pg/mL (<50 years), ≥150 pg/mL (50-74 years), or ≥300 pg/mL (≥75 years). Outcomes included all-cause death and the first hospitalization for heart failure event.
Results:
In the Atherosclerosis Risk in Communities, 12.1% had prevalent heart stress and 12.3% developed incident heart stress over a 6-year interval. Both prevalent and incident heart stress were associated with greater risks of all-cause death (adjusted hazard ratio, 1.58 [95% confidence interval, 1.45-1.73] and 1.68 [1.52-1.86]) and hospitalization for HF (adjusted hazard ratio, 1.77 [1.55-2.02] and 2.23 [1.94-2.56]). Persistent heart stress conferred the greatest risk, whereas heart stress remission was associated with a lower mortality risk. In the Multi-Ethnic Study of Atherosclerosis, 13.0% had prevalent heart stress and 7.8% developed incident heart stress over a 4-year interval, with consistent associations with adverse outcomes.
Conclusions:
Heart stress is common, dynamic, and significantly associated with adverse outcomes in community populations. Future studies should investigate whether mitigating heart stress can prevent HF development.
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