B-type natriuretic peptide levels and insulin resistance in patients with severe ischemic myocardial dysfunction

Abstract

B-type natriuretic peptide (BNP) is an important clinical parameter of severity in congestive heart failure (CHF). Recent findings suggest a close relation between lipid and glucose metabolism and the natriuretic peptide axis, even if conflicting data exist on the relationship between natriuretic peptide levels and insulin resistance (IR). Thus, we sought to investigate potential relations between BNP level and IR in 134 patients with severe ischemic myocardial dysfunction [mean+/-SD: age =64.8+/-9.6 yr, male/female =104/30; body mass index (BMI) =25.5+/-4.05 kg/m2, 26.1% diabetics; ejection fraction (EF) = 30.2+/-7.7%]. In univariate analysis, an inverse relationship between BNP levels and EF% was observed (R=-0.43, p=0.0006). Moreover, we found an inverse association between BNP levels and BMI (R=-0.27, p=0.036), and also between BNP and homeostasis model assessment of insulin resistance (HOMA-IR) (R=-0.27, p=0.039). In multivariate analysis, EF% and HOMA-IR were significantly and independently associated with logarithmically transformed BNP levels (beta=-0.40, p=0.019 and beta=-0.26, p=0.042, respectively; R2=0.36). In conclusion, in patients with severe ischemic myocardial dysfunction EF and IR are independently associated with BNP levels explaining about 1/3 of the variability of this parameter. Multiple potential mechanisms may underlie this association, but it seems now clinically important to take into account also metabolic features when interpreting plasma natriuretic peptide concentrations obtained for diagnostic or prognostic purposes.

N-terminal pro-B-type natriuretic peptide and insulin resistance in overweight and obese subjects

“…Plasma BNP/NT-proBNP values are inversely related to body mass index (BMI) in both healthy subjects and patients with heart failure (Hubert et al, 1983;Clerico et al, 1999;Taylor et al, 2006;Tosa et al, 2009;Clerico et al, 2012). Several studies have reported various association of natriuretic peptides levels with insulin resistance (Olsen et al, 2005;Alcelik et al, 2007;Wang et al, 2007;Tassone et al, 2009). Recently, Khan et al (2011) reported that natriuretic peptide levels are lower both in non-obese and obese patients with insulin resistance.…”