# PORTHOS: NT-proBNP-afkapwaarden onbetrouwbaar bij obese patiënten — risico op gemiste hartfalendiagnose

*geplaatst 2026-05-11 · Hartfalen · European Journal of Heart Failure · doi 10.1093/ejhf/xuag154 · https://hartvaat.nl/2026/05/10/porthos-nt-probnp-afkapwaarden-onbetrouwbaar-bij-obese-patienten-risico-op-gemis/*

PORTHOS — Portugese populatie-gebaseerde screeningstudie bij volwassenen ≥50 jaar (n=2.498) — onderzocht of vaste NT-proBNP-afkapwaarden adequaat zijn om hartfalen uit te sluiten bij mensen met obesitas. BMI vertoonde een sterke inverse associatie met NT-proBNP: per 5 kg/m² stijging daalde NT-proBNP met ~50 pg/mL. Obese deelnemers met NT-proBNP <125 pg/mL hadden hogere kans op hartfalensymptomen (OR 1,97; 95% BI 1,15–3,38) en echocardiografische afwijkingen (OR 3,63; 95% BI 1,27–10,4) dan slanke deelnemers met NT-proBNP ≥125 pg/mL — ondanks dat ze 9 jaar jonger waren en mediaan viervoudig lagere NT-proBNP-waarden hadden (59 vs 235 pg/mL). Conclusie: obesitas verlaagt NT-proBNP systematisch ondanks meer hartfalensymptomen en structurele afwijkingen. Vaste afkapwaarden missen hartfalen in deze groeiende populatie. Aanpassing van de screening-afkappunten in CVRM-richtlijnen verdient overweging — vooral bij huisartsenscreening waar NT-proBNP de eerste stap is.

## English: 

PORTHOS (Portugal, population-based, age ≥50, n=2,498) shows NT-proBNP is systematically lower in obesity — ~50 pg/mL lower per 5 kg/m² BMI increase. Obese participants with NT-proBNP <125 pg/mL had higher odds of HF symptoms (OR 1.97) and echo abnormalities (OR 3.63) than lean participants above the cut-off, despite being 9 years younger and having 4x lower NT-proBNP (59 vs 235 pg/mL). Fixed cut-offs miss HF in obesity; primary-care screening pathways need adjustment.

## Abstract (original, from the publication)

Background: Obesity is linked to heart failure, particularly with preserved ejection fraction, but is associated with lower natriuretic peptide levels, potentially leading to underdiagnosis. Aims: To examine the association between adiposity measures — body mass index, waist circumference, and waist-to-height ratio — and N-terminal pro-B-type natriuretic peptide levels, and to determine if lower cut-offs should be used to rule out heart failure in individuals with obesity. Methods: PORTHOS is a 2023 population-based study in Portugal including adults aged 50 years or older. Participants underwent NT-proBNP screening, followed by clinical and echocardiographic assessment in those with levels ≥125 pg/mL, self-reported heart failure, or a 5% random sample with levels <125 pg/mL. Results: Among 2,498 participants, obesity prevalence ranged from 25% using body mass index ≥30 kg/m² to >70% using waist-to-height ratio ≥0.6. Body mass index showed a strong inverse association with NT-proBNP, with approximately 50 pg/mL lower levels per 5 kg/m² increase. Individuals with obesity and NT-proBNP <125 pg/mL had higher odds of heart-failure symptoms (OR 1.97, 95% CI 1.15–3.38) and echocardiographic abnormalities (OR 3.63, 95% CI 1.27–10.4) than lean participants with NT-proBNP ≥125 pg/mL — despite being 9 years younger and having fourfold lower median NT-proBNP (59 vs 235 pg/mL). Conclusions: Obesity is associated with lower NT-proBNP levels despite a higher burden of symptoms and structural abnormalities. Fixed cut-offs do not reliably exclude heart failure in individuals with obesity.

Auteurs: Cristina Gavina, João Pedro Ferreira, Lígia Lopes Mendes, Filipa Bernardo, Sara Gonçalves

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Bron: European Journal of Heart Failure, https://doi.org/10.1093/ejhf/xuag154. Bijgewerkt 2026-07-03T18:39:32Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.