Association Between Cardiac Natriuretic Peptides and Lipid Profile: a Systematic Review and Meta-Analysis

Spannella, Francesco; Giulietti, Federico; Bordicchia, Marica; Burnett, John C.; Sarzani, Riccardo

doi:10.1038/s41598-019-55680-z

Cited by 16 publications

(20 citation statements)

References 106 publications

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“…It could be speculated that higher cardiac NT-proBNP levels in physiological conditions may be protective against type 2 diabetes and also against CVD ( 3 , 36 ), acting against obesity and dysregulation of glucose/lipid metabolism, while higher levels in pathological conditions may represent a rescue mechanism of the cardiovascular system, which attempts to counteract the pathology by releasing the cardiac hormones. In line with previous studies ( 37 ), higher NT-proBNP levels were associated with a more favorable lipid profile, which are characterized by lower triglycerides and higher HDL-cholesterol concentrations in our study. This relation may further substantiate a positive role of NT-proBNP on cardiometabolic and cardiovascular risks in healthy physiology.…”

Section: Discussionsupporting

confidence: 93%

Opposing Associations of NT-proBNP With Risks of Diabetes and Diabetes-Related Complications

et al. 2020

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Circulating N-terminal pro B-type natriuretic peptide (NT-proBNP) is a classic diagnostic and prognostic marker for heart failure. However, it is inversely associated with diabetes risk. We aimed to investigate relationships of NT-proBNP with risk of diabetes-related complications in initially healthy individuals. RESEARCH DESIGN AND METHODSWe performed a case-cohort study within the European Prospective Investigation Into Cancer and Nutrition (EPIC)-Potsdam cohort including a random subcohort (n 5 1,294) and incident cases of type 2 diabetes (n 5 649) and cardiovascular diseases (n 5 478). Incident cases of type 2 diabetes (n 5 545) were followed up for microvascular (n 5 133) and macrovascular (n 5 50) complications. Plasma NT-proBNP was measured at baseline in initially healthy participants. RESULTSIn multivariable models, NT-proBNP was linearly inversely associated with incident type 2 diabetes with a hazard ratio (HR) (95% CI) per doubling in NT-proBNP of 0.91 (0.86, 0.98). The association was only observable in women (0.80 [0.72, 0.90]) compared with men (0.98 [0.91, 1.07]). Among people with incident diabetes, NT-proBNP was positively associated with diabetes complications:

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Section: Discussionsupporting

confidence: 93%

Opposing Associations of NT-proBNP With Risks of Diabetes and Diabetes-Related Complications

et al. 2020

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“…The natriuretic peptides have been demonstrated to be inversely associated with risk of developing obesity and diabetes (26,27). Moreover, a recent meta-analysis has demonstrated an association between higher levels of natriuretic peptides and favorable lipid profiles (28). This to some extent contrasts with the findings of this and other studies demonstrating that higher levels of natriuretic peptides are risk markers for CV and renal complications of diabetes.…”

Section: Possible Mechanismscontrasting

confidence: 72%

Comparison of Natriuretic Peptides as Risk Markers for All-Cause Mortality and Cardiovascular and Renal Complications in Individuals With Type 1 Diabetes

et al. 2020

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OBJECTIVE Few studies have compared midregional proatrial natriuretic peptide (MR-proANP) and N-terminal probrain natriuretic peptide (NT-proBNP). We compared their value as risk markers for all-cause mortality and cardiovascular (CV) and renal complications in individuals with type 1 diabetes. RESEARCH DESIGN AND METHODS MR-proANP and NT-proBNP were measured in 664 individuals. Hazard ratios (HRs) were assessed per doubling of NT-proBNP or MR-proANP for risk of a composite of ischemic events, heart failure (HF), a combined renal end point of end-stage kidney disease (ESKD), decline in estimated glomerular filtration rate (eGFR) ≥30%, and all-cause mortality or individual end points. Adjustments included CV risk factors and addition of MR-proANP or NT-proBNP. RESULTS Median follow-up was 5.1–6.2 years. MR-proANP was associated with higher risk of all-cause mortality (n = 57; HR 1.7, 95% CI 1.1–2.7), combined CV end point (n = 94; 1.6, 1.1–2.2), HF (n = 27; 2.8, 1.5–5.2), combined renal end point (n = 123; 1.6, 1.2–2.1), and ESKD (n = 21; 3.1, 1.2–7.8) independent of CV risk factors (P ≤ 0.02). After addition of NT-proBNP, significance for all end points was lost. A doubling of NT-proBNP was associated with higher risk of all-cause mortality (HR 1.5, 95% CI 1.2–1.8), the combined CV end point (1.3, 1.1–1.5), HF (1.7, 1.3–2.1), and the combined renal end point (1.3, 1.1–1.4) independent of CV risk factors (model 2 [P < 0.001]) and MR-proANP (model 3 [P ≤ 0.03]). There was no association with decline in eGFR ≥30% (n = 93). CONCLUSIONS Higher NT-proBNP was independently associated with all-cause mortality, CV disease, HF, and the combined renal end point. MR-proANP was associated with all end points but decline in eGFR, although not independent of NT-proBNP. MR-proANP may contribute to the predictive value of NT-proBNP for risk stratification in type 1 diabetes.

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“…The increase in renal perfusion, owing to the improved cardiac function, could partially explain the effects of sacubitril/valsartan on kidney, especially in the HF setting. Moreover, natriuretic peptides (NPs) affect several organs and systems, exerting multiple cardio‐metabolic activities 32–35 . The kidneys, together with the adipose tissue, are the organs where NP receptors are mainly expressed, as well as neprilysin, which is mostly expressed in the brush border of proximal renal tubular cells 36,37 .…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, natriuretic peptides (NPs) affect several organs and systems, exerting multiple cardio-metabolic activities. [32][33][34][35] The kidneys, together with the adipose tissue, are the organs where NP receptors are mainly expressed, as well as neprilysin, which is mostly expressed in the brush border of proximal renal tubular cells. 36,37 Neprilysin inhibition, mediated by sacubitril, likely increases the renal NP bioavailability.…”

Section: Pathophysiological Considerationsmentioning

confidence: 99%

Effect of sacubitril/valsartan on renal function: a systematic review and meta‐analysis of randomized controlled trials

et al. 2020

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A worsening renal function is prevalent among patients with cardiovascular disease, especially heart failure (HF). Sacubitril/valsartan appears to prevent worsening of renal function and progression of chronic kidney disease (CKD) as compared with renin-angiotensin system (RAS) inhibitors alone in HF patients. It is unclear whether these advantages are present in HF patients only, or can be extended to other categories of patients, in which this drug was studied. We performed a systematic review and meta-analysis to assess the consistency of effect size regarding renal outcome across randomized controlled trials (RCTs) that compared sacubitril/valsartan with RAS inhibitors in patients with or without HF. We searched Medline (PubMed), Scopus, and Thomson Reuters Web of Science databases until June 2020. We took into account RCTs that compared sacubitril/valsartan with a RAS inhibitor and reported data regarding renal function. We used random-effects models to obtain summary odds ratio (OR) with 95% confidence interval (CI). We extracted hazard ratios for renal outcomes, glomerular filtration rate slopes or rates of renal adverse events. Sensitivity analyses were performed by moderator analysis and random-effects meta-regression. The search revealed 10 RCTs (published between 2012 and 2019) on 16 456 subjects. Sacubitril/valsartan resulted in a lower risk of renal dysfunction as compared with RAS inhibitors alone [k ¼ 10; pooled OR ¼ 0.70 (95% CI 0.57-0.85); P < 0.001], with a moderate inconsistency between studies [Q(9) ¼ 15.18; P ¼ 0.086; I 2 ¼ 40.73%]. A stronger association was found in studies including older patients (k ¼ 10; β ¼ À0.047730; P ¼ 0.020) or HF patients with preserved ejection fraction [pooled OR ¼ 0.53 (0.41-0.68) vs. 0.76 (0.57-1.01) for studies on HF patients with reduced ejection fraction; P for comparison ¼ 0.065]. The effect size did not change with different comparators (angiotensin-converting enzyme inhibitors vs. angiotensin II type 1 receptor blockers, P ¼ 0.279). No significant association was found when the analysis was restricted to studies on non-HF patients [k ¼ 3; pooled OR ¼ 0.86 (0.61-1.22); P ¼ 0.403] and studies with high risk of bias [k ¼ 3; pooled OR ¼ 0.34 (0.08-1.44); P ¼ 0.143]. Our findings support the role of sacubitril/valsartan on preservation of renal function, especially in older patients and HF patients with preserved ejection fraction. However, evidence is currently limited to HF patients, while the renal outcome of sacubitril/valsartan therapy outside the HF setting needs to be further investigated.

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Association Between Cardiac Natriuretic Peptides and Lipid Profile: a Systematic Review and Meta-Analysis

Cited by 16 publications

References 106 publications

Opposing Associations of NT-proBNP With Risks of Diabetes and Diabetes-Related Complications

Opposing Associations of NT-proBNP With Risks of Diabetes and Diabetes-Related Complications

Comparison of Natriuretic Peptides as Risk Markers for All-Cause Mortality and Cardiovascular and Renal Complications in Individuals With Type 1 Diabetes

Effect of sacubitril/valsartan on renal function: a systematic review and meta‐analysis of randomized controlled trials

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