Heart Failure
"Heart Stress" as a Pre-HF Stage — NT-proBNP in ARIC and MESA
- Authors: ARIC + MESA collaboration
- Journal / date: Journal of Cardiac Failure, 2026
- DOI / URL: 10.1016/j.cardfail.2026.04.017 | PMID 42128201
- Source basis: Abstract only
- Study type: Two community cohorts
- Population: ARIC n=10,977 (validated in MESA n=4825), all CVD-free at baseline with NT-proBNP measured
- Exposure: Age-specific "heart stress" definition by NT-proBNP — ≥75 pg/mL (<50 yr), ≥150 pg/mL (50-74), ≥300 pg/mL (≥75) in asymptomatic adults
- Key findings (ARIC):
- 12.1% prevalent heart stress; 12.3% developed it over 6 years (very dynamic)
- Prevalent heart stress: all-cause death HR 1.58 (1.45-1.73); first HF hospitalization HR 1.77 (1.55-2.02)
- Incident heart stress: death HR 1.68; HHF HR 2.23
- Persistent stress carried the highest risk; remission reduced mortality
- MESA validated the pattern
- Why it matters (clinical takeaway):
- Operationalizes a practical, age-specific NT-proBNP threshold to flag pre-HF (AHA Stage A/B) patients for intensified prevention — SGLT2i, GLP-1 agonists, BP/lipid control.
- "Heart stress" is dynamic, so serial NT-proBNP (e.g., annually) in at-risk patients can identify remission as well as progression — supports biomarker-guided prevention rather than one-off screening.
- Useful complement to the CKM staging framework (same issue) for prevention-clinic triage.
- Caveats / limitations: Observational, no randomized intervention demonstrated to reduce HF from screening + treating "heart stress." Threshold-based definition may misclassify near-cutoff patients.
- Referenced trials pulled forward: None this pass. STOP-HF and similar BNP-guided prevention trials worth a deep-dive next month.