N-Terminal Pro-B-Type Natriuretic Peptide Level Is Depressed in Patients With Significant Coronary Artery Disease Who Have High Body Mass Index

Abstract

SUMMARYThe aim of this study was to determine how body mass index (BMI) influences the N-terminal pro-B-type natriuretic peptide (NT-proBNP) level in patients with significant coronary artery disease (CAD).A total of 348 patients (61.5 ± 9.2 years, male 67.5%) who had normal left ventricular systolic function were enrolled. All patients underwent percutaneous coronary intervention. We excluded patients with acute myocardial infarction, chronic heart failure, or renal dysfunction. Baseline NT-proBNP level was measured on admission. All underwent follow-up (F-U) coronary angiography (CAG) and the F-U NT-proBNP level was measured before F-U CAG. The patients were divided into two groups: an NT-proBNP < 100 pg/ mL group (group I, n = 228) and an NT-proBNP > 200 pg/mL group (group II, n = 120). BMI was significantly higher in group I than that in group II (26.5 ± 2.2 versus 22.9 ± 2.5 kg/m 2 , P < 0.001). The level of NT-proBNP was negatively correlated with BMI and the levels of hemoglobin and apolipoprotein A1, and positively correlated with age, lipoprotein (a), and the Gensini score. In multivariate analysis, BMI was significantly related to a low NT-proBNP level in patients with CAD (odds ratio, 6.83; 95% confidence interval, 2.67-17.47; P < 0.001).The NT-proBNP level was not elevated in patients with a high BMI despite having significant CAD, and BMI was significantly related to a low NT-proBNP level in patients with significant CAD. (Int Heart J 2008; 49: 403-412)

Impact of Body Mass Index on Plasma N-Terminal ProB-Type Natriuretic Peptides in Chinese Atrial Fibrillation Patients without Heart Failure

“…In this study, the average level (around 24.7 kg/m 2 ) and distribution of BMI was comparable with other Asian studies [4], [13], but it was much lower in comparison with the western populations (around 28 kg/m 2 ) [2], [3], [5], [7]. Of this study populations, 46% was normal weight (BMI<25 kg/m 2 ), 51% overweight (BMI = 25–29.9 kg/m 2 ), and 3% obese (BMI≥30 kg/m 2 ).…”

“…Several recent reports suggest that obesity, as indexed by elevated body mass index (BMI), may also affect NT-proBNP levels, with lower circulating levels in those with higher BMI in subjects with acute or chronic heart failure [2], [3], significant coronary artery disease or acute myocardial infarction [4], [5] and healthy general populations [6]. However, isolated study showed that obesity is not statistically associated with NT-proBNP in asymptomatic patients with hypertension [7].…”

Impact of obesity on the prognostic value of the N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with acute myocardial infarction

“…Log adjustment was used to account for the skewed distribution of NT-proBNP. Nevertheless, the consistency of our results with similar studies in heart failure7 16 or in patients undergoing percutaneous coronary intervention with a preserved LVEF10 also support the validity of our clinical findings.…”

“…Among these factors, BMI emerged as one of the most powerful determinants of circulating levels of the propeptide; a 3% decrease in NT-proBNP value was found per unit increase in BMI. A similar relationship has also been reported in chronic stable heart failure7 18 or in patients with a preserved LVEF undergoing percutaneous coronary intervention 10. The validity of our findings, on a large sample size of more than 2000 patients, is supported by its consistency across both sexes, by the adjustment methods with numerous covariates, including LVEF, and by the use of matching procedures.…”

Natriuretic peptides and cardiovascular damage in the metabolic syndrome: molecular mechanisms and clinical implications

“…Moreover, ANP infusion immediately after coronary angioplasty in patients with acute myocardial infarction has been able to prevent LV dilation and remodelling more efficiently than isosorbide dinitrate [86]. On the other hand, in patients with CAD, low levels of NT-proBNP are inversely correlated with BMI, with the NTproBNP levels not elevated in patients with CAD and high BMI [92]. Thus low NP levels may contribute to the pro-inflammatory state, as well as to the endothelial dysfunction and reduced coronary reserve in obese patients with the MS.…”