Repeat heart marker test may sharpen CV risk in older adults

Clinical takeaway: Compare a high NT-proBNP in an older patient against any earlier result drawn outside an acute illness. The direction of change may inform cardiovascular and mortality risk more than either value alone. 

N-terminal pro–B-type natriuretic peptide (NT-proBNP), a blood marker of cardiac wall stress, shows up in charts for reasons that have nothing to do with cardiovascular prevention. The test might be drawn during a dyspnea workup, an ED visit, or a preop panel, and the number lands in the record whether or not anyone planned to act on it. In an older patient with no cardiac history, a mildly high result raises a question with no clean answer: does this reflect something worth pursuing? 

CV prevention gets harder to chase after about age 75. Competing mortality risks are real, the margin of benefit for statins and antihypertensives narrows, and the usual risk calculators lose discrimination. New long-term data from a large cohort of older adults without prior cardiovascular disease suggest useful information sits in how this cardiac marker shifts over time. 

Compared with adults whose levels stayed below the threshold at both draws, those who developed elevation by the three-year draw had about seven more cardiovascular events per 100 by year eight. Those elevated at both draws had a similar excess. Deaths followed the same pattern: roughly six more per 100 with newly elevated levels and about eight more with persistent elevation. 

Interestingly, adults whose levels had fallen back below the threshold by the three-year draw finished with cardiovascular and mortality risks close to those who were never elevated. 

The cohort study drew on ASPREE, an aspirin prevention trial in community-dwelling adults age 70 and older, plus its observational extension. Investigators measured the marker in 8,454 participants at enrollment and again three years later, sorted them by whether elevation against an age-specific threshold was absent, resolved, new, or persistent, and tracked deaths and a composite of MI, stroke, coronary death, and heart failure hospitalization for a median of eight years. 

An elevated result for an older patient should prompt a chart review to determine if an earlier, non-acute value exists; the comparison says more than either number alone. What the data do not necessarily support is a new testing regimen. Elevation tracks with kidney function, rhythm, and age itself, and the authors are explicit that this marker reflects subclinical cardiac dysfunction rather than a treatment target. 

Source: Cai A, et al. (2026 Aug 18) Ann Intern Med. Longitudinal Changes in Heart Stress and the Risk for Cardiovascular Disease and Mortality in Older Adults: An Observational Study