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)

Abstract

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.

Possible Enzymatic Downregulation of the Natriuretic Peptide System in Patients with Reduced Systolic Function and Heart Failure: A Pilot Study

“…In addition to HF, natriuretic peptide levels are also modulated by body mass index and other conditions such as age, sex, and other illnesses [ 15 ]. We found that natriuretic peptide levels were the highest in those with the most severe HF, who also had the lowest BMIs.…”

“…We found that natriuretic peptide levels were the highest in those with the most severe HF, who also had the lowest BMIs. Although BMI and HF have opposite effects on natriuretic peptide levels, elevated BNP levels in HF patients still are associated with a poor prognosis [ 15 ]. The natriuretic peptides are believed to have protective effects in dHF by opposing the action of the renin-angiotensin-aldosterone system [ 3 ].…”

Relationship between body mass index, cardiovascular biomarkers and incident heart failure

“…Specifically, NT‐proBNP and MR‐proANP negatively correlated with BMI after accounting for potential confounders. Indeed, obesity is known to be inversely related to NP concentrations, both in HF patients 13–15 as well as in the general population, 5 and it has been hypothesized that obesity‐associated lowering of NPs may primarily be due to suppression of NP production/release rather than increased degradation 4 . This is because NT‐proBNP, unlike BNP, is not cleared via NP receptor‐C or through neprilysin‐mediated mechanisms.…”

“…Nadruz and colleagues observed that in patients with chronic HF and reduced ejection fraction, NPs had a diminished prognostic value for cardiovascular death/HF admission in individuals with severe obesity 13 . However, in two other studies enrolling patients with acutely decompensated HF, BMI did not modify associations of NPs with 180‐day death 14,15 …”

Pharmacology of Cardio-Oncology: Chronotropic and Lusitropic Effects of B-Type Natriuretic Peptide in Cancer Patients with Early Diastolic Dysfunction Induced by Anthracycline or Nonanthracycline Chemotherapy

“…An inverse correlation has been suggested to occur between BMI and BNP or Nt-proBNP (Bhatt et al, 2018;Braunwald, 2008;Das et al, 2005). We characterized whether transient or persistent elevations of Nt-proBNP occurred in patients showing a lower BMI at T0 or a significant decrease of BMI at T1.…”