Relationship between body mass index, cardiovascular biomarkers and incident heart failure

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BACKGROUND: There are limited data examining whether body-mass index (BMI) influences the association between cardiovascular biomarkers and incident heart failure (HF).

METHODS AND RESULTS: Thirteen biomarkers representing key HF domains were measured: N-terminal-pro-B-type natriuretic peptide (NT-proBNP), mid-regional-pro-A-type natriuretic peptide (MR-proANP), cardiac troponin-T (cTnT), C-reactive protein, procalcitonin, galectin-3, C-terminal pro-endothelin-1 (CT-pro-ET-1), mid-regional pro-adrenomedullin, plasminogen activator inhibitor-1, copeptin, renin, aldosterone and cystatin-C. Associations of biomarkers with BMI were examined using linear regression models, and with incident HF using Cox regression models. We selected biomarkers significantly associated with incident HF, and evaluated whether BMI modified these associations.

RESULTS: Among 8202 individuals, 41% were overweight (BMI 25-30kg/m2 ), and 16% were obese (BMI≥30kg/m2 ). Mean age of the cohort was 49 years (range 28-75), and 50% were women. All biomarkers except renin were associated with BMI: inverse associations were observed with NT-proBNP, MR-proANP, CT-pro-ET-1 and aldosterone whereas positive associations were observed with the remaining biomarkers (Pall ≤0.001). During 11.3±3.1 years follow-up, 357 HF events were recorded. Only NT-proBNP, MR-proANP and cTnT remained associated with incident HF (P<0.001), and a significant biomarker*BMI interaction was not observed (Pint >0.1). Combined NT-proBNP and cTnT measurements modestly improved performance metrics of the clinical HF model in overweight (ΔC-statistic=0.024; LHRχ2 =38; P<0.001) and in obese (ΔC-statistic=0.020; LHRχ2 =32; P<0.001) individuals.

CONCLUSIONS: Plasma concentrations of several cardiovascular biomarkers are influenced by obesity. Only NT-proBNP, MR-proANP and cTnT were associated with incident HF, and BMI did not modify these associations. A combination of NT-proBNP and cTnT improves HF risk prediction in overweight and in obese individuals. This article is protected by copyright. All rights reserved.

Original languageEnglish
Number of pages7
JournalEuropean Journal of Heart Failure
Early online date14-Jan-2021
Publication statusPublished - 8-Feb-2021


  • Body mass index
  • Cardiovascular biomarkers
  • Heart failure
  • Associations
  • Predictive value
  • General population

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