Impact of Body Mass and Body Composition on Circulating Levels of Natriuretic Peptides

Das, Sandeep R; Drazner, Mark H.; Dries, Daniel L.; Vega, Gloria Lena; Stanek, Harold G.; Abdullah, Shuaib; Canham, Russell M.; Chung, Anne K.; Léonard, David; Wians, Frank H.; Lemos, James A. de

doi:10.1161/circulationaha.105.555573

Cited by 386 publications

(335 citation statements)

References 17 publications

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“…In the abovementioned large-scale study, diabetes was another condition found to be in association with low plasma NP levels and the negative effects of obesity and diabetes on NP levels were reported to be additive. 4 The results of the study conducted by Das et al 1 was comparable with those of Wang et al 4 such that the subjects with lower NT-proBNP levels were less likely to have hypertension. On the contrary, diabetes was found to be a lowering factor for this molecule.…”

Section: Discussionsupporting

confidence: 59%

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The association of brain natriuretic peptide and insulin resistance in obesity-related hypertension

Cikim

2007

J Hum Hypertens

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Hypertension is frequently associated with obesity and natriuretic peptide levels are reported to decrease in obese subjects. Both the lower brain natriuretic peptide (BNP) concentration and insulin resistance are suggested to be associated with hypertension. However, their involvement in obesity-related hypertension has not been clearly defined. Forty-four obese women (21 normotensive and 23 hypertensive) and 25 healthy women matched for age were included in the study. Anthropometrical parameters were determined. Serum BNP, fasting insulin and glucose concentrations, and lipid parameters were evaluated. Insulin resistance was calculated using Homeostasis Model Assessment (HOMA) and Quantative Insulin Sensitivity Check Index (QUICKI) formulations. Within the obese groups, HOMA and QUICKI reflected the increased insulin resistance in hypertensive obese subjects with a significant correlation to blood pressure. The decrease in BNP in the obese groups was in favour of the hypertensive obese subjects (31.4376.43; 26.3674.29; and 17.5173.08 pg/ ml, respectively) with a fractional statistical significance between the hypertensive obese group and the controls (P ¼ 0.047). Only for the obese hypertensive group, fasting glucose, HOMA and QUICKI were significantly correlated with BNP. Moreover, fasting plasma glucose (R 2 ¼ 0.22, P ¼ 0.007) and fasting plasma insulin (R 2 ¼ 0.39, P ¼ 0.03) were independently correlated with BNP only for the obese hypertensive group. It can be concluded that the decrease in BNP concentrations in the obese hypertensive subjects seem to be well correlated with the insulin resistance.

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Section: Discussionsupporting

confidence: 59%

“…[1][2][3] In several studies, plasma ANP and BNP concentrations have been found to be decreased in obese subjects. [4][5][6][7] Additionally, an increase in natriuretic peptides (NPs) has been reported to parallel an increase in blood pressure.…”

Section: Introductionmentioning

confidence: 99%

The association of brain natriuretic peptide and insulin resistance in obesity-related hypertension

Cikim

2007

J Hum Hypertens

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“…14 An inverse association between body mass index (BMI) and NP levels has been consistently documented. 15 -17 Data from the Dallas Heart Study demonstrated an inverse association between lean mass, but not fat mass, with BNP and NT-proBNP levels (Figure 1), 18 an effect that appears to be mediated through a suppressive effect of androgens on NP synthesis. 19 This finding may be particularly important in the elderly, given the known reduction in lean mass/adipose tissue ratio and testosterone that occurs with aging 18 : lower lean mass and testosterone may contribute to age-associated increases in NP levels.…”

Section: Impact Of Aging-related Factors On Npsmentioning

confidence: 98%

B‐type Natriuretic Peptides in Acute Coronary Syndromes: Implications in an Aging Population

Krim

Vivo

Lemos³

2012

Clinical Cardiology

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B-type natriuretic peptide (BNP) and N-terminal-proBNP (NT-proBNP) are increasingly recognized as prognostic markers in patients with acute coronary syndrome (ACS). The need for novel and more effective tools for risk assessment cannot be more emphasized than in older patients with ACS given their atypical presentation, multiple comorbidities, and higher risk for mortality and morbidity. Accurate interpretation of B-type NP values in older patients with ACS, however, may be confounded by several aging-related physiologic changes. Advanced age, reduction in body mass, and kidney function and anemia have been associated with higher BNP and NT-proBNP concentrations, and may create challenges with interpreting NP levels in the elderly. This review highlights the need to better understand the physiology of BNP and NT-proBNP in older individuals and their prognostic value in older patients with ACS. IntroductionThe prognostic role of B-type natriuretic peptide (BNP) and N-terminal-proBNP (NT-proBNP) in acute coronary syndromes (ACS) remains the subject of vigorous investigation reflecting the growing interest in improving risk stratification strategies for affected patients. While a compelling body of evidence demonstrates that these biomarkers independently predict adverse outcomes, a few issues of uncertainty limit their routine use in clinical decision making. One is the question of whether existing evidence can be extrapolated to the older population. This is an important issue as approximately 82% of deaths from coronary artery disease (CAD) occur in individuals age 65 or older. 1 Fundamental to examining the value of BNP and NT-proBNP in older persons with CAD is identifying aging-related factors that may influence their levels. This review summarizes current literature describing the value of these biomarkers in older patients with ACS. The relationship of BNP and NT-proBNP with advanced age and its associated physiologic alterations is also reviewed.

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“…Median levels of NT‐proBNP were >5500 pg/mL lower in patients with Class III obesity as compared with nonobese patients. Multiple analyses have reported similar findings 7, 8, 18. Mechanisms may include increased clearance of natriuretic peptides attributed to enzymes found in adipocytes and elevated glomerular filtration rates in the obese patient 19.…”

Section: Discussionmentioning

confidence: 75%

“…BNP and/or NT‐proBNP levels correlate with HF diagnosis, severity, and mortality 4, 5. However, obesity may be associated with lower circulating levels of BNP and/or NT‐proBNP 6, 7, 8, 9. Thus, the prognostic utility of NT‐proBNP may differ between obese and nonobese patients, though this has not been well characterized in patients with acute HF.…”

Section: Introductionmentioning

confidence: 99%

Interaction of Body Mass Index on the Association Between N‐Terminal‐Pro‐b‐Type Natriuretic Peptide and Morbidity and Mortality in Patients With Acute Heart Failure: Findings From ASCEND‐HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure)

Bhatt

Cooper

Ambrosy

et al. 2018

JAHA

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BackgroundHigher body mass index (BMI) is associated with lower circulating levels of N‐terminal‐pro‐b‐type natriuretic peptide (NT‐proBNP). The Interaction between BMI and NT‐proBNP with respect to clinical outcomes is not well characterized in patients with acute heart failure.Methods and ResultsA total of 686 patients from the biomarker substudy of the ASCEND‐HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated HF ) clinical trial with documented NT‐proBNP levels at baseline were included in the present analysis. Patients were classified by the World Health Organization obesity classification (nonobese: BMI <30 kg/m2, Class I obesity: BMI 30–34.9 kg/m2, Class II obesity BMI 35–39.9 kg/m2, and Class III obesity BMI ≥40 kg/m2). We assessed baseline characteristics and 30‐ and 180‐day outcomes by BMI class and explored the interaction between BMI and NT‐proBNP for these outcomes. Study participants had a median age of 67 years (55, 78) and 71% were female. NT‐proBNP levels were inversely correlated with BMI (P<0.001). Higher NT‐proBNP levels were associated with higher 180‐day mortality (adjusted hazard ratio for each doubling of NT‐proBNP, 1.40; 95% confidence interval, 1.16, 1.71; P<0.001), but not 30‐day outcomes. The effect of NT‐proBNP on 180‐day death was not modified by BMI class (interaction P=0.24).ConclusionsThe prognostic value of NT‐proBNP was not modified by BMI in this acute heart failure population. NT‐proBNP remains a useful prognostic indicator of long‐term mortality in acute heart failure even in the obese patient.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00475852.

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Impact of Body Mass and Body Composition on Circulating Levels of Natriuretic Peptides

Cited by 386 publications

References 17 publications

The association of brain natriuretic peptide and insulin resistance in obesity-related hypertension

The association of brain natriuretic peptide and insulin resistance in obesity-related hypertension

B‐type Natriuretic Peptides in Acute Coronary Syndromes: Implications in an Aging Population

Interaction of Body Mass Index on the Association Between N‐Terminal‐Pro‐b‐Type Natriuretic Peptide and Morbidity and Mortality in Patients With Acute Heart Failure: Findings From ASCEND‐HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure)

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