Heart failure & cardiomyopathiesMeta-analysis
Natriuretic Peptides, Body Mass Index, and Clinical Outcomes in Heart Failure With Mildly Reduced or Preserved Ejection Fraction
- Participant-level pooled analysis of 4 randomised outcomes trials
- 4 global randomized outcomes trials
Authors' conclusion
In this analysis, current NT-proBNP thresholds substantially underestimated the absolute risk of adverse HF outcomes among persons with higher BMI.
Study context
- Population
- Adults with HFmrEF/HFpEF
- Participants
- 14,750 adults · 4 RCTs
- Comparison
- NT-proBNP association with outcomes by body mass index (BMI)
- Outcome
- CV death or heart failure (HF) hospitalization (also CV death, all-cause death) by NT-proBNP, according to BMI
- Follow-up
- Median 2.8 years
Pooled result
As reported in the abstract
CV death or HF hospitalization per doubling of baseline NT-proBNP · median 2.8 years
Hazard ratio
1.40
95% CI 1.36–1.43
P < 0.001
Each doubling of baseline NT-proBNP
HR 1.40 (95% CI 1.36–1.43); P < 0.001
Each doubling of baseline NT-proBNP, as printed
- Association appeared incrementally blunted with higher baseline BMI
- P for interaction = 0.008
Further pooled results
| Outcome | Values |
|---|---|
| NT-proBNP at same absolute risk (5 events per 100 person-years), no AF | BMI ≥35 kg/m² 158 pg/mL · BMI <35 kg/m² 450 pg/mL |
| Absolute risk of CV death or HF hospitalization at a contemporary NT-proBNP trial eligibility threshold | BMI <30 kg/m² 3.5 per 100 person-years · BMI ≥40 kg/m² 7.3 per 100 person-years |
Original publication
Natriuretic Peptides, Body Mass Index, and Clinical Outcomes in Heart Failure With Mildly Reduced or Preserved Ejection Fraction. J Am Coll Cardiol. Published 27 August 2025. doi:10.1016/j.jacc.2025.08.028
Summarised from the published abstract; every number is checked against it