Heart Failure Guidelines May Miss Risk in People With Obesity
Heart Failure Guidelines May Miss Risk in People With Obesity
Source: Circulation: Heart Failure – August 28, 2025
1. Background
• 2022 AHA/ACC/HFSA HF guidelines use NT-proBNP ≥125 pg/mL to reclassify patients from Stage A (at-risk) → Stage B (pre-HF).
• Concern: People with obesity have lower NP levels, which may underestimate risk.
2. Study Design
• Analysis of >32,000 adults without HF from community cohorts.
• Compared classification using 2013 guidelines (no NP) vs 2022 guidelines (with NP).
3. Comparison of Guidelines
• 2013 guidelines: did not use natriuretic peptides (NPs).
• 2022 guidelines: added NP threshold (125 pg/mL) to move patients from Stage A (at risk) → Stage B (pre-HF).
• Problem: Obese patients have naturally lower NP levels → risk may be underestimated.
4. Guideline Implications
• Current single threshold (125 pg/mL) may miss risk in obese patients.
• Authors suggest lower NP cut-offs for obesity.
5. Expert Commentary:
• Future guidelines may use a matrix of NP thresholds adjusted for obesity, CKD, etc.
• Clinicians should consider other risk factors, not only NP levels.
6. Conclusion
• NP-based classification underestimates HF risk in obesity.
• Study provides evidence for refining cut-points in future HF guidelines.
