Manifold implications of obesity in ischemic heart disease among Japanese patients according to covariance structure analysis: Low reactivity of B-type natriuretic peptide as an intervening risk factor

Abstract

Background/ObjectivesObesity is believed to be one of the major risk factors for cardiovascular disease in Western countries. However, the effects of obesity should be continuously examined in the Japanese population because the average bodily habitus differs among countries. In this study, we collectively examined the significance of obesity and obesity-triggered risk factors including the low reactivity of B-type natriuretic peptide (BNP), for ischemic heart disease (IHD) in Japanese patients.Methods and resultsThe study patients consisted of 1252 subjects (IHD: n = 970; non-IHD: n = 282). Multiple logistic regression analysis revealed that dyslipidemia, hypertension, diabetes, and the low reactivity of BNP were significant risk factors for IHD, but body mass index (BMI) was not. A theoretical path model was proposed by positioning BMI at the top of the hierarchical model. Exploratory factor analysis revealed that BMI did not play a causative role in IHD (P = NS). BMI was causatively linked to other risk factors (P<0.001 for hypertension; P<0.001 for dyslipidemia; P<0.001 for HbA1c; P<0.001 for LogBNP), and these factors played a causative role in IHD (P<0.001 for hypertension; P<0.001 for dyslipidemia; P<0.001 for HbA1c; P<0.001 for LogBNP). The intrinsic power of the low reactivity of BNP induced by high BMI on the promotion of IHD was fairly potent.ConclusionThis study demonstrated that obesity per se is not a strong risk factor for IHD in Japanese patients. However, several important risk factors triggered by obesity exhibited a causative role for IHD. The low reactivity of BNP is a substantial risk factor for IHD.

Increased Levels of Cardiac Troponin I in Subjects with Extremely Low B-type Natriuretic Peptide Levels

“…Because of the cardio-protective effects exerted by BNP, we hypothesized that the increased risk of IHD in individuals with obesity is due not only to well-known risk factors (e.g., hypertension, dyslipidaemia, diabetes) but also to the compromised cardio-protection of the reduced BNP level. By a covariance structure analysis in 1,252 patients with cardiac disorders, we confirmed that low BNP level, as well as hypertension, dyslipidaemia and haemoglobin A1c (HbA1c), but not body mass index (BMI) was significantly associated with the incidence of IHD (p < 0.001) 16 . To confirm this hypothesis further, by using cTnI as an indicator of cardiac disorders in this study, we assessed whether low BNP level was associated with an enhanced cardiovascular risk in the general population.…”

Association between plasma B-type natriuretic peptide and anaemia in heart failure with or without ischaemic heart disease: a retrospective study

“…The indirect effect was determined by multiplying the path coefficients of the intervening variables. Recently, we reported our research by applying a covariance structure analysis 19–24. In addition, as covariance structure analysis consists partly of the Bayesian estimation method and the Bayesian adaptive trial design, Bayesian structural equation modelling successfully gave a description of this result, and it is expected to be a next-generation statistical procedure for mega-trials 28.…”

“…Serum biochemical analyses and plasma BNP level measurements were performed in a central laboratory in our hospital during the study. Plasma BNP level was measured as described in previous reports 14 15 19 20 23. In brief, whole blood (5 mL) was collected in tubes containing ethylenediaminetetraacetic acid disodium salt (1 mg/mL blood).…”

“…In many areas, covariance structure analysis plays an important role in understanding how the relationships between observed variables might be generated by interaction effects and/or hypothesised latent variables. Recently, we successfully introduced this statistical approach in the cardiovascular field 19–24. The aim of this study is graphically represented in figure 1.…”

A Highly-sensitized Response of B-type Natriuretic Peptide to Cardiac Ischaemia Quantified by Intracoronary Pressure Measurements

“…The results of the path model described in www.nature.com/scientificreports www.nature.com/scientificreports/ as the degree of obesity becomes more severe 23,34 . Importantly, we also reported that the plasma BNP levels were relatively low in patients with chronic IHD compared with those of non-IHD patients 35 and that the low reactivity of BNP could play a causative role in IHD 36 . We believe that treatment of obesity will be beneficial for preventing IHD in part by increasing endogenous natriuretic peptide levels.…”