TOPLINE:

Adults with obesity had lower levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), and many with NT-proBNP levels below the usual rule-out threshold (125 pg/mL) had higher odds of signs and symptoms of heart failure (HF) and structural heart abnormalities than lean adults with NT-proBNP levels ≥ 125 pg/mL.

METHODOLOGY:

• Researchers used data from a Portuguese cross-sectional study (PORTHOS, 2022-2023) to assess how common measures of adiposity were linked to NT‑proBNP levels and whether standard NT-proBNP cutoffs missed HF in people with obesity.
• They included 2498 adults aged 50 years or older (60.2%-64.6% women). Adults advanced to detailed assessments if the screening NT-proBNP level was ≥ 125 pg/mL or if they reported a prior diagnosis of HF. A 5% random sample of adults with NT-proBNP levels < 125 pg/mL (and no prior HF) was included as control.
• Assessments included the New York Heart Association (NYHA) symptom questionnaire, a 12-lead ECG, comprehensive transthoracic echocardiography, and laboratory testing (including for NT-proBNP levels).
• People with obesity were categorised using BMI (< 30 vs ≥ 30), waist circumference (< 88 vs ≥ 88 cm in women and < 102 vs ≥ 102 cm in men), and the waist to height ratio (< 0.6 vs ≥ 0.6).

TAKEAWAY:

• Overall, 25.4% of adults had obesity by BMI criteria, 74.3% had elevated waist circumference, and 70.2% had an elevated waist to height ratio.
• Adults with BMI ≥ 30 had lower levels of NT-proBNP (P = .001). Each 5-unit increase in BMI was associated with 46.9 pg/mL decrease in NT-proBNP levels (P < .001).
• Adults with obesity and NT-proBNP levels < 125 pg/mL were more likely to have signs and symptoms of HF (adjusted odds ratio [aOR], 1.97) and echocardiographic abnormalities (aOR, 3.63) and be in NYHA class II or higher (aOR, 1.67) than lean adults with NT-proBNP ≥ 125 pg/mL (P < .05 for all).
• Adults with obesity and NT-proBNP levels 125-239 pg/mL (median, 164 pg/mL) had higher odds of symptoms of HF and left ventricular hypertrophy than lean peers with NT-proBNP levels ≥ 240 pg/mL (median, 423 pg/mL; P < .01 for both).

IN PRACTICE:

"[The study] findings suggest that, among people with obesity and a high cardiovascular risk, a NT-pro BNP [NT-proBNP] < 125 pg/mL may not rule out the presence of HF," the researchers of the study wrote.

SOURCE:

The study was led by Cristina Gavina, MD, PhD, of Sociedade Portuguesa de Cardiologia in Lisbon, Portugal. It was published online on May 10, 2026, in the European Journal of Heart Failure.

LIMITATIONS:

The study was conducted in a single Portuguese cohort without external validation. The subgroup of adults with obesity and NT‑proBNP levels < 125 pg/mL was small. The study lacked longitudinal follow‑up data.

DISCLOSURES:

The PORTHOS study received funding from AstraZeneca Portugal. One author reported being employed by the funding agency. Several authors reported receiving research grants, contracts, consulting or advisory fees (including payments for lectures, presentations, speakers bureaus, and manuscript writing), speaker honoraria or travel support, and support for attending meetings or educational events from pharmaceutical or medical-device companies including the funding agency. Some authors reported serving on data safety monitoring or advisory boards for industry. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.