NT-proBNP strongly linked to HFpEF risk among early menopausal women

Menopause status does not appear to modify the association between N-terminal pro B-type natriuretic peptide (NT-proBNP), a biomarker of heart failure (HF), and the risk of HF with reduced ejection fraction (HFrEF), according to a study. However, this association is more pronounced among women on their early menopause.

The study used data from the Atherosclerosis Risk in Communities study Visit 4 and included 4,352 postmenopausal women (mean age 63.5 years), including 1,174 with early menopause, who were free of HF at baseline.

Researchers performed binary log-transformation to measure NT-proBNP. They also applied Cox proportional hazards models to evaluate the association of NT-proBNP with incident HF, and separately for incident HF with preserved ejection fraction (HFpEF), and incident HFrEF. The analyses included testing for effect modification by early menopause.

Over a mean follow-up of 16.5 years, 881 HF events were documented. The interaction effect between NT-proBNP and early menopause was significant for incident HFrEF (p_interaction=0.03) but not for incident HF (p_interaction=0.95) and incident HFpEF (p_interaction=0.17).

Each doubling of NT-proBNP levels was associated with a more than 30-percent increased risk of incident HF among women with early menopause (adjusted hazard ratio [aHR], 1.33, 95 percent confidence interval [CI], 1.20–1.47) and those without (aHR, 1.34, 95 percent CI, 1.24–1.44).

The corresponding aHR estimates for every doubling of NT-proBNP levels among women with and without early menopause were 1.57 (95 percent CI, 1.34–1.86) and 1.38 (95 percent CI, 1.24–1.54), respectively, for incident HFpEF; and 1.68 (95 percent CI, 1.42-1.99) and 1.36 (95 percent CI, 1.22-1.52), respectively, for incident HFrEF.