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.