News · Heart & Metabolic
A raised heart-strain marker that came back down carried no extra risk eight years later
Most risk markers are measured once and treated as a verdict. An Annals of Internal Medicine analysis of 8,454 adults measured one twice, three years apart, and people whose reading normalized ended up where those who never had it did.
- 8,454 ASPREE participants, mean age 78 at year 3, none with prior cardiovascular disease.
- NT-proBNP measured at enrollment and again at 3 years, giving four trajectory groups.
- Over a median 8 years: 818 cardiovascular events and 1,584 deaths.
- Incident heart stress added 7.4% absolute cardiovascular risk; sustained 6.7%.
- The remission group had similar adjusted absolute risks to the persistently free group.
Almost every risk marker in medicine is measured once and then quoted forever. Your cholesterol from three years ago is in your notes. So is the blood pressure the nurse took while you were annoyed about parking.
That is a problem, because a single reading cannot tell you whether a person is getting worse, getting better, or was simply having a bad morning. Writing in Annals of Internal Medicine, researchers took a marker that is usually read once and read it twice.
They followed 8,454 older adults with a mean age of 78 and no prior heart disease, who had NT-proBNP, a protein the heart releases when its walls are stretched, measured at trial enrollment and year 3.
The group whose raised reading came back down finished the study where the people who never had a raised reading finished it.
Four groups instead of two
Measuring twice turns one question into a better one.
Heart stress status, based on changes in NT-proBNP concentrations from enrollment to year 3, was examined in 4 categories: persistently free, remission, incident, or sustained. Somebody whose reading was high at both visits is in a different situation from somebody whose reading rose between them, and both differ from somebody whose reading fell.
A single measurement collapses all of that into one number and calls it risk.
The result that matters
Over a median follow-up of 8.0 years, 818 cardiovascular events and 1,584 deaths occurred.
The two groups that did badly were the expected ones. At year 8, compared with the persistently free category, the adjusted absolute risks for total cardiovascular disease were increased by 7.4% for incident heart stress and 6.7% for sustained heart stress. The same pattern held for deaths, increased for all-cause mortality by 6.1% and 7.5%.
Then the interesting group. The remission category had similar adjusted absolute risks to those of the persistently heart-stress-free group.
People who had a raised marker, and no longer did, were not carrying a scar from it. Eight years later they looked like people who had never had one.
Why that is more than a statistical curiosity
A marker that predicts your future is interesting. A marker that describes your present is useful.
If a raised reading were a permanent stamp, knowing about it would be information without a use: you would learn your odds and have nothing to do about them. What this suggests instead is that the number tracks a state the heart can be in and can come out of.
Heart failure means that your heart can’t pump enough oxygen-rich blood to meet your body’s needs, and in most cases it develops slowly from long-term medical conditions. Those conditions, high blood pressure most of all, are treatable. A marker that falls when they are treated, and that carries the person’s risk down with it, is measuring the thing you would want it to measure.
What the study cannot tell you
Nobody was treated to bring the number down, and this is the limitation that governs everything else.
The remission group got better for reasons the study did not assign and mostly did not record. Some had blood pressure brought under control. Some lost weight, or recovered from an illness that was straining the heart at the first measurement. Some may have had a high first reading for reasons that were never really about the heart.
Because of that, this cannot say that lowering the marker lowers risk. It says that people in whom it fell had the outcomes of people in whom it was never raised, which is compatible with the marker being a faithful readout of an underlying problem that improved.
The authors list two further limits plainly: an observational design and predominantly White participants. Their claim is correspondingly modest, that heart stress status based on longitudinal changes may improve risk stratification.
What to do with this if you are 75
Nothing involving a blood test, and that is the honest answer.
This is not a screening test. It is a diagnostic test for suspected heart failure being used here as a research instrument, and no guideline recommends measuring it repeatedly in people who feel well.
What the finding does support is something less specific and more useful: that in your late seventies, the state of your heart is still moving. A raised marker at 75 was not a verdict for the people in this study, and the ones in whom it settled were indistinguishable eight years later from those who never had it.
As we age, our minds and bodies change, and having a healthy lifestyle can help you deal with those changes. That is the sort of sentence that usually reads as filler. Here there is a measurement behind it.
People also ask
What did the study find?
At year 8, compared with the persistently heart-stress-free category, the adjusted absolute risks for total CVD were increased by 7.4% (95% CI 4.8% to 10.0%) for incident heart stress and 6.7% (4.3% to 9.0%) for sustained heart stress. Adjusted absolute risks for all-cause mortality were increased by 6.1% (3.7% to 8.5%) and 7.5% (5.2% to 9.8%). The remission category had similar adjusted absolute risks to those of the persistently free group.
What is NT-proBNP?
A protein fragment the heart releases when its walls are stretched. It is the standard blood test for suspected heart failure, and above a certain age-adjusted level it is described as heart stress even in people with no symptoms and no diagnosis.
What are the four groups?
Persistently free, remission, incident and sustained. They are defined by whether the marker was raised at enrollment, at year three, at both, or at neither. That is the whole innovation: measuring twice instead of once.
Why does remission matter so much?
Because it turns a marker into something that can be acted on. If a raised reading were a fixed verdict, knowing it would change nothing. If people whose reading comes back down end up where people who never had it end up, the reading is describing a state rather than a fate.
Does this prove that lowering the marker lowers risk?
No. Nobody was treated to bring the number down. People whose reading normalized may have done so because the underlying problem improved, which is not the same as the number itself mattering. This is an observational analysis.
How large is the effect in absolute terms?
About 7 extra cardiovascular events per 100 people over eight years for the incident group. That is a meaningful difference in a population of adults in their late seventies who started with no cardiovascular disease at all.
Should anyone ask for this test?
Not on this evidence. NT-proBNP is a diagnostic test used when heart failure is suspected, not a screening test for well people, and no guideline recommends repeating it to track risk. This is general information rather than medical advice.