Clinical benefits after physical training in patients with HF are associated with blunting of adrenergic overactivity and of natriuretic peptide overexpression.

Background C-type natriuretic peptide (CNP) is structurally related to cardiac natriuretic peptides and is currently considered as an endothelium-derived hyperpolarizing factor. Endothelial dysfunction, commonly observed in chronic heart failure (HF) patients is positively affected by physical training. Methods To evaluate the effect of aerobic physical training on the expression of CNP, 90 HF patients on optimal pharmacological treatment (age 62 ± 2 years, mean ± SEM), randomly assigned in a 3 : 1 ratio to either control group (C, 19 patients) or home-based aerobic exercise-training program group (T, 71 patients), completed the protocol. Plasma assay of CNP, brain natriuretic peptide or B-type natriuretic peptide (BNP), and norepinephrine; echocardiogram; and cardiopulmonary-stress test were performed in all patients at enrollment and after 9 months. Results At baseline, in both groups, CNP plasma level was significantly related to BNP (R = 0.50), ejection fraction (R = 0.43), and peak oxygen uptake (VO 2 , R = 0.43, all P < 0.001). After 9 months, trained patients showed an improvement in peak VO 2 (P < 0.001) and ejection fraction (P < 0.05), whereas norepinephrine (P < 0.05), BNP (P < 0.001), and CNP (P < 0.001) decreased. No changes occurred in group C. In group T, the decrease in CNP was significantly related to the increase in peak VO 2 (R = 0.31, P < 0.01), and the relation between CNP and BNP was preserved at the end of the program (R = 0.41, P < 0.001).Conclusion Clinical and functional improvement after physical training in HF patients is associated with a decrease in adrenergic activation and in both CNP and BNP concentration. Changes in CNP plasma concentration after physical training might reflect an improvement in endothelial function. Changes in peak oxygen uptake, norepinephrine, BNP, and CNP plasma values for trained (open circles) and untrained patients (closed circles) at baseline and after 9 months. *P < 0.05, wP < 0.001 vs. baseline; #P < 0.05 vs. untrained patients. BNP, brain natriuretic peptide; CNP, C-type natriuretic peptide; VO 2 , peak oxygen uptake.CNP and physical training Passino et al.

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Conclusions: Data from two independent cohorts indicate that use of snus is associated with a higher risk of heart failure. This may have public health implications.Background: Heart failure (HF) is a common complication of cardiovascular (CV) diseases and is more severe and prevalent in elderly patients, especially when they have hypertension.