LAUSR

Background: The prognostic implications of achieving NT-proBNP concentrations ≤1000 pg/mL among obese patients having heart failure with reduced ejection fraction (HFrEF) are not completely known. We evaluated the prognostic implications of body mass index (BMI), and achievement of target NT-proBNP levels of ≤1000 pg/mL in obese HF patients from the GUIDE-IT trial. Methods: Survival analysis using multivariable-adjusted Cox proportional hazard models was used to evaluate the risk of adverse cardiovascular (CV) events (HF hospitalization or CV mortality) based on the achievement of target NT-proBNP (≤1000 pg/mL), stratified by obesity status (obese [≥30 kg/m 2 ] and non-obese [<30kg/m 2 ]). Achievement of NT-proBNP ≤1000 pg/mL was treated as a time-varying measure. We also assessed the risk of the study outcome stratified by baseline obesity status and across BMI quartiles, taking NT-proBNP as a time-varying covariate. Results: Compared to non-obese patients, obese patients were mostly younger, Black, females with 59% (95% CI: 39.5-83.5%) lower adjusted NT-proBNP levels. The risk of adverse CV outcomes was 55% lower in obese (HR: 0.45 [95% CI: 0.28-0.74]) and 70% lower in non-obese (HR: 0.30 [95% CI: 0.17-0.51]) HF patients who achieved the target NT-proBNP, compared to their counterparts who did not achieve the target NT-proBNP ( Figure 1 ). The was no interaction between obesity and achievement of target NT-proBNP on the study outcome (p>0.10). Obese patients at baseline had a greater risk of developing adverse CV events (HR: 1.52 [95% CI: 1.13-2.03]) compared to non-obese patients. Patients in the third (HR: 1.49 [95% CI: 1.03-2.17]) and fourth BMI quartile (HR: 2.04 [95% CI: 1.36-3.01]) had a higher risk of adverse CV events, compared to those in the first quartile. Conclusion: Achievement of NT-proBNP ≤1000 pg/mL has favorable prognostic implications irrespective of obesity status. Obese HF patients had a greater risk of adverse CV events than non-obese patients.