Patients aged ≥ 50 years, with NT-proBNP ≥ 125 pg/ml, without a history of HF, meeting the International Federation for the Surgery of Obesity and Metabolic Disorders criteria (i.e. body mass index (BMI) ≥ 35 kg/m2 with an obesity-related co-morbidity or BMI ≥ 40 kg/m2), and who underwent an echocardiogram due to elevated NT-proBNP levels were included. This evidence concerns the gene NPPB and metabolic disease.