Reference Ranges for NT-proBNP (N-Terminal Pro-B-Type Natriuretic Peptide) and Risk Factors for Higher NT-proBNP Concentrations in a Large General Population Cohort

Abstract

Background: Demographic differences in expected NT-proBNP (N-terminal pro-B-type natriuretic peptide) concentration are not well established. We aimed to establish reference ranges for NT-proBNP and explore the determinants of moderately elevated NT-proBNP under the universal definition of heart failure criteria. Methods: This is a cross-sectional study. NT-proBNP was measured in serum from 18 356 individuals without previous cardiovascular disease in the Generation Scotland Scottish Family Health Study. Age- and sex-stratified medians and 97.5th centiles were generated. Sex stratified risk factors for moderately elevated NT-proBNP (≥125 pg/mL) were investigated. Results: In males, median (97.5th centile) NT-proBNP concentration at age <30 years was 21 (104) pg/mL, rising to 38 (195) pg/ml at 50 to 59 years, and 281 (6792) pg/mL at ≥80 years. In females, median NT-proBNP at age <30 years was 51 (196) pg/mL, 66 (299) pg/mL at 50 to 59 years, and 240 (2704) pg/mL at ≥80 years. At age <30 years, 9.8% of females and 1.4% of males had elevated NT-proBNP, rising to 76.5% and 81.0%, respectively, at age ≥80 years. After adjusting for risk factors, an NT-proBNP ≥125 pg/mL was more common in females than males (OR, 9.48 [95% CI, 5.60–16.1]). Older age and smoking were more strongly associated with elevated NT-proBNP in males than in females ( P sex interaction <0.001, 0.07, respectively). Diabetes was inversely associated with odds of elevated NT-proBNP in females only ( P sex interaction =0.007). Conclusions: An NT-proBNP ≥125 pg/mL is common in females without classical cardiovascular risk factors as well as older people. If NT-proBNP becomes widely used for screening in the general population, interpretation of NT-proBNP levels will require that age and sex-specific thresholds are used to identify patients with potential pathophysiology.

CMR detects decreased myocardial deformation in asymptomatic patients at risk for heart failure

“…Table 1 shows an age difference between the three groups, the difference between the youngest, the control subjects, and the HFpEF group was 19 years. This finding might suggest that the results reflect changes in elderly constitutions also supported by higher NT-proBNP values in the older group ( 15 ). However, we believe that our findings reflect different disease stages which are also influenced by age, but the main age-depended factor influencing both serum biomarkers and cardiac constitutions is atrial fibrillation which was excluded while recruiting the subjects.…”

Serum Pro‐N‐Cadherin Is a Marker of Subclinical Heart Failure in the General Population

“…There is no established biomarker known to the literature that is predictive of heart failure independent of age, sex, BMI, or comorbidities that can be used clinically as a community‐based screening tool for subclinical heart failure. 24 , 35 Because this is the first report with evidence of serum PNC as a biomarker for subclinical heart failure, more studies will be necessary to establish clinical cutoffs and practical utility of serum PNC as a biomarker of subclinical heart failure in the clinical setting.…”

Natriuretic Peptides in Clinical Practice: A Current Review

“…Although current guidelines have not recommend gender-specific natriuretic peptide thresholds, most studies have found that natriuretic peptides are higher in females than males [62][63][64] . Differences around 10 pg/ml in BNP and 100% in NT-proBNP between genders have been observed 62,63 .…”

“…Although current guidelines have not recommend gender-specific natriuretic peptide thresholds, most studies have found that natriuretic peptides are higher in females than males [62][63][64] . Differences around 10 pg/ml in BNP and 100% in NT-proBNP between genders have been observed 62,63 . This difference is not well understood but some that explanations have been proposed: ranging from hormonal influence on gene expression and gender differences in obesity to extra-cardiac sources of natriuretic peptides within the female productive system 63,64 .…”