Longitudinal Heart Stress Assessment Improves Prediction of Cardiovascular Outcomes

Dynamic indicators that reflect evolving cardiac stress could better identify individuals at heightened risk. Serial testing of N-terminal pro-B-type natriuretic peptide (NT-proBNP) offers a way to track heart stress over time. A new study shows that longitudinal changes in this marker may improve CVD and mortality risk stratification in community-dwelling older adults.

Southern Medical University (Guangzhou, China) investigators evaluated a “heart stress (HS) status” metric derived from three-year changes in NT-proBNP. NT-proBNP was measured at trial enrollment and again at year 3, and participants were categorized as persistently HS-free, HS remission, incident HS, or sustained HS. The analysis tested whether these serial, biomarker-defined states aligned with subsequent cardiovascular disease (CVD) events and all-cause mortality.

The cohort included 8,454 community-dwelling older adults without prior CVD. Over a median follow-up of 8.0 years, researchers recorded 818 CVD events and 1,584 deaths. Risk estimates were summarized as adjusted absolute risks at year 8.

Compared with the persistently HS-free group, adjusted absolute risk for total CVD rose by 7.4% among those with incident HS and by 6.7% among those with sustained HS at year 8. For all-cause mortality, adjusted absolute risks increased by 6.1% and 7.5% for the incident HS and sustained HS categories, respectively. The HS remission category showed adjusted absolute risks similar to those in the persistently HS-free group.

The findings were published online on August 18, 2026, in Annals of Internal Medicine. The authors indicated that additional research is needed to determine whether HS status based on serial NT-proBNP values can guide care to reduce CVD and mortality risk in older adults.

“Future studies should determine whether HS status based on serial values of NT-proBNP can inform care to reduce CVD and mortality risk in an older adult population,” the authors write.

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