NT-proBNP as a predictor of all-cause mortality in a population of insurance applicants.

Objective: Quantify the independent value of NT-proBNP in predicting all-cause mortality for individual life insurance applicants and establish risk-based reference ranges.

Method: By use of the Social Security Death Master File and multivariate analysis, relative mortality was determined for 144,027 life insurance applicants tested (almost all routinely rather than for cause) for NT-proBNP along with other laboratory testing and measurement of BP and BMI.

Results: Risk increased substantially for NT-proBNP values > 300 pg/mL in women and > 200 pg/mL in men after age, smoking status and other cardiovascular risk factors were accounted for. The relative risk reached > 10 fold at NT-proBNP levels > 1000 pg/mL. For those age 50 to 89 and denying a history of heart disease, this level occurred in only 0.5% of applicants but was present in 7% of all deaths.

Conclusion: NT-proBNP is a strong independent predictor of all-cause mortality but values associated with increased risk vary by sex.