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Longitudinal Changes in Heart Stress and the Risk for Cardiovascular Disease and Mortality in Older Adults : An

Anping Cai1, Antoni Bayes-Genis2, Rory Wolfe3

  • 1Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China (A.C., Y.F., Y.Z.).

Annals of Internal Medicine
|August 17, 2026
PubMed

Insights

Changes in heart stress (HS) status, indicated by NT-proBNP levels, can predict cardiovascular disease (CVD) and mortality risk in older adults. Monitoring these changes offers improved risk assessment for better health outcomes.

Area of Science:

  • Cardiology
  • Geriatrics
  • Biomarkers

Background:

  • Age-specific elevations in NT-proBNP concentrations, termed "heart stress" (HS), are linked to adverse cardiovascular disease (CVD) outcomes.
  • Longitudinal changes in NT-proBNP may refine CVD risk assessment in elderly populations.

Purpose of the Study:

  • To assess the association between heart stress (HS) status, defined by 3-year NT-proBNP changes, and the risk of total CVD and all-cause mortality.
  • To evaluate HS status in community-dwelling older adults without a history of CVD.

Main Methods:

  • An observational study involving 8454 participants from the ASPREE trial and its extension (ASPREE-XT).
  • NT-proBNP levels were measured at enrollment and year 3.
  • Participants were categorized into four HS statuses: persistently HS-free, HS remission, incident HS, or sustained HS.

Main Results:

  • Over 8 years of follow-up, incident HS and sustained HS were associated with increased absolute risks for total CVD and all-cause mortality compared to the persistently HS-free group.
  • Specifically, incident HS showed a 7.4% increase in CVD risk and a 6.1% increase in mortality risk.
  • HS remission was associated with similar risks to the persistently HS-free group.

Conclusions:

  • Heart stress (HS) status, determined by longitudinal NT-proBNP changes, may enhance the risk stratification for cardiovascular disease (CVD) and mortality in older adults.
  • This approach could lead to more personalized and effective preventative strategies.
Abstract

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