ELEVATED NT-proBNP levels are strongly associated with an increased risk of atrial fibrillation (AF), particularly in older adults.
Atrial fibrillation (AF) is a common cardiac arrhythmia with significant implications for morbidity and mortality, underscoring the need for effective risk prediction tools. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a widely used biomarker in heart failure management, but its role in predicting AF risk remains unclear. This meta-analysis investigated the association between NT-proBNP levels and AF incidence, aiming to assess its potential for enhancing AF risk prediction models.
A systematic search of PubMed, Embase, the Cochrane Library, Web of Science, and Scopus was conducted up to August 2024. Sixteen prospective cohort studies involving 136,089 participants and 8,017 incident AF cases were included. Pooled analyses revealed that individuals in the highest quartile of NT-proBNP levels had a 3.84-fold higher risk of developing AF compared to those in the lowest quartile (95% CI 3.03 to 4.87). Each standard deviation increase in NT-proBNP levels was associated with a 70% greater AF risk (RR=1.70, 95% CI 1.54 to 1.88). A significant non-linear dose-response relationship was observed (P<0.05), with stronger associations identified in older populations and studies utilising serum samples. Incorporating NT-proBNP into traditional AF risk models significantly improved predictive accuracy, indicating its potential utility in clinical risk stratification.
These findings suggest that NT-proBNP levels can serve as a powerful biomarker for identifying individuals at increased risk of AF, particularly among older adults. Incorporating NT-proBNP into clinical practice may enhance early detection and targeted prevention strategies, paving the way for more personalised AF risk management. Future research should explore the feasibility and cost-effectiveness of NT-proBNP-based screening in broader population settings, as well as its integration into real-world clinical workflows.
Katrina Thornber, EMJ
Reference
Wang W et al. Association between NT-proBNP levels and risk of atrial fibrillation: a systematic review and meta-analysis of cohort studies. Heart. 2024;DOI:10.1136/heartjnl-2024-324685.
