Obesity and Serial NT-proBNP Levels in Guided Medical Therapy for Heart Failure With Reduced Ejection Fraction: Insights From the GUIDE-IT Trial.
Obesity and Serial NT-proBNP Levels in Guided Medical Therapy for Heart Failure With Reduced Ejection Fraction: Insights From the GUIDE-IT Trial.
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DOI：
10.1161/jaha.120.018689
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发表时间：
2021-04-06
影响因子：
5.4
通讯作者：
Arora P
中科院分区：
文献类型：
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作者：
Parcha V;Patel N;Kalra R;Suri SS;Arora G;Wang TJ;Arora P
肥胖患者的NT-proBNP（N-末端前B-型利钠肽）水平较低。在接受生物标志物指导治疗的肥胖心力衰竭（HF）患者中，NT‐proBNP水平≤1000 pg/mL的预后意义尚不完全清楚。我们在GUIDE‐IT（使用生物标志物强化治疗指导HF循证治疗）试验受试者中评估了肥胖和NT‐proBNP水平（≤1000 pg/mL）的预后意义。基于NT‐proBNP ≤1000 pg/mL（作为时变协变量），使用多变量校正的考克斯比例风险模型评估不良心血管事件（HF住院或心血管死亡）的风险，并按肥胖状态分层。还根据基线时的体重指数评估了研究结局。使用似然比检验评估NT‐proBNP对不良心血管事件的预测能力。与非肥胖患者相比，肥胖患者多为年轻人、黑人和女性。肥胖个体的NT‐proBNP水平低59.0%（95% CI，39.5%-83.5%）。与不存在NT-proBNP水平≤1000 pg/mL的患者相比，肥胖（风险比[HR]，0.48; 95% CI，0.29-0.59）和非肥胖（HR，0.32; 95% CI，0.19-0.57）HF患者发生不良心血管事件的风险较低。肥胖与NT‐proBNP ≤1000 pg/mL之间对研究结果无交互作用（P>0.10）。与非肥胖患者相比，肥胖患者发生不良心血管事件的风险更大（HR，1.39; 95%CI，1.01-1.90）。NT‐proBNP是肥胖和非肥胖患者不良心血管事件风险的最强预测因子。无论肥胖状态如何，治疗中NT-proBNP水平≤1000 pg/mL均具有有利的预后意义。在这项试验中，NT‐proBNP水平是肥胖和非肥胖个体心血管事件的最强预测因子。URL：https://www.clinicaltrials.gov;唯一标识符：NCT 01685840。
Obese patients have lower NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) levels. The prognostic implications of achieving NT‐proBNP levels ≤1000 pg/mL in obese patients with heart failure (HF) receiving biomarker‐guided therapy are not completely known. We evaluated the prognostic implications of obesity and having NT‐proBNP levels (≤1000 pg/mL) in the GUIDE‐IT (Guiding Evidence‐Based Therapy Using Biomarker‐Intensified Treatment in HF) trial participants. The risk of adverse cardiovascular events (HF hospitalization or cardiovascular mortality) was assessed using multivariable‐adjusted Cox proportional hazard models based on having NT‐proBNP ≤1000 pg/mL (taken as a time‐varying covariate), stratified by obesity status. The study outcome was also assessed on the basis of the body mass index at baseline. The predictive ability of NT‐proBNP for adverse cardiovascular events was assessed using the likelihood ratio test. Compared with nonobese patients, obese patients were mostly younger, Black race, and more likely to be women. NT‐proBNP levels were 59.0% (95% CI, 39.5%–83.5%) lower among obese individuals. The risk of adverse cardiovascular events was lower in obese (hazard ratio [HR], 0.48; 95% CI, 0.29–0.59) and nonobese (HR, 0.32; 95% CI, 0.19–0.57) patients with HF who had NT‐proBNP levels ≤1000 pg/mL, compared with those who did not. There was no interaction between obesity and having NT‐proBNP ≤1000 pg/mL on the study outcome (P>0.10). Obese patients had a greater risk of developing adverse cardiovascular events (HR, 1.39; 95% CI, 1.01–1.90) compared with nonobese patients. NT‐proBNP was the strongest predictor of adverse cardiovascular event risk in both obese and nonobese patients. On‐treatment NT‐proBNP level ≤1000 pg/mL has favorable prognostic implications, irrespective of obesity status. NT‐proBNP levels were the strongest predictor of cardiovascular events in both obese and nonobese individuals in this trial. URL: https://www.clinicaltrials.gov; Unique identifier: NCT01685840.