Potent influence of obesity on suppression of plasma B-type natriuretic peptide levels in patients with acute heart failure: An approach using covariance structure analysis

Kinoshita, Koji; Kikuchi, Makoto; Minai, Kosuke; Ogawa, Kazuo; Inoue, Yasunori; Yoshimura, Michihiro

doi:10.1016/j.ijcard.2016.04.111

Cited by 20 publications

(30 citation statements)

References 27 publications

(32 reference statements)

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“…To confirm the contribution of the plasma glucose levels to ΔK, we performed a covariance structure analysis as in our previous study [14]. This analysis compares the power among the multiple independent variables, which confound each other.…”

Section: Methodsmentioning

confidence: 99%

“…However, given that HOMA-IR can be confounded by serum glucose and insulin levels, multiple regression analysis cannot be conducted at the same time. A covariance structure analysis is therefore useful for understanding how relationships among observed variables might be generated by hypothesized latent variables in many areas [14]. The path model, a platform of the covariance structure analysis, is proposed based on the scientific knowledge, abundant experience, steady concept, and clear direction of the study.…”

Section: Introductionmentioning

confidence: 99%

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Possible increase in insulin resistance and concealed glucose-coupled potassium-lowering mechanisms during acute coronary syndrome documented by covariance structure analysis

et al. 2017

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ObjectiveAlthough glucose-insulin-potassium (GIK) therapy ought to be beneficial for ischemic heart disease in general, variable outcomes in many clinical trials of GIK in acute coronary syndrome (ACS) had a controversial impact. This study was designed to examine whether “insulin resistance” is involved in ACS and to clarify other potential intrinsic compensatory mechanisms for GIK tolerance through highly statistical procedure.Methods and resultsWe compared the degree of insulin resistance during ACS attack and remission phase after treatment in individual patients (n = 104). During ACS, homeostasis model assessment of insulin resistance (HOMA-IR) values were significantly increased (P<0.001), while serum potassium levels were transiently decreased (degree of which was indicated by ΔK) (P<0.001). This finding provides a renewed paradox, as ΔK, a surrogate marker of intrinsic GIK cascade activation, probably reflects the validated glucose metabolism during ischemic attack. Indeed, multiple regression analysis revealed that plasma glucose level during ACS was positively correlated with ΔK (P = 0.026), whereas HOMA-IR had no impact on ΔK. This positive correlation between ΔK and glucose was confirmed by covariance structure analysis with a strong impact (β: 0.398, P = 0.015). Intriguingly, a higher incidence of myocardial infarction relative to unstable angina pectoris, as well as a longer hospitalization period were observed in patients with larger ΔK, indicating that ΔK also reflects disease severity of ACS.ConclusionsInsulin resistance most likely increases during ACS; however, ΔK was positively correlated with plasma glucose level, which overwhelmed insulin resistance condition. The present study with covariance structure analysis suggests that there are potential endogenous glucose-coupled potassium lowering mechanisms, other than insulin, regulating glucose metabolism during ACS.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Possible increase in insulin resistance and concealed glucose-coupled potassium-lowering mechanisms during acute coronary syndrome documented by covariance structure analysis

et al. 2017

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“…However, the input factors should be carefully selected when planning covariance structure analyses, and the path model based on covariance structure analysis should be proposed on the basis of scientific knowledge, abundant experience, consistent concepts and the clear direction of the study. We recently proposed path models to explain complex phenomena, including plasma BNP levels [22]. …”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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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.

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“…The obtained structural equation models were tested and confirmed at the significance level for P values of <0.05. The implementation procedures of covariance structure analysis have been described previously [18]. The causality model defines certain hierarchical regression models that compare clinical factors in organic stenosis and ACS.…”

Section: Methodsmentioning

confidence: 99%

“…The path model, which is based on covariance structure analysis, should be proposed based on a well-defined concept and a clear direction of the study. Recently, we reported our research using covariance structure analysis in a tangible way [18]. …”

Section: Introductionmentioning

confidence: 99%

Parallel comparison of risk factors between progression of organic stenosis in the coronary arteries and onset of acute coronary syndrome by covariance structure analysis

et al. 2017

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BackgroundIt is widely accepted that progression of organic stenosis in the coronary arteries and onset of acute coronary syndrome (ACS) are similar in the development of atherosclerosis. However, the extent of the association of each risk factor with the respective pathological conditions has not been fully elucidated.ObjectivesWe investigated the differences in risk factors between these conditions using a statistical procedure.MethodsThe study population consisted of 1,029 patients with ischemic heart disease (IHD). We divided the study population into two groups (ACS and non-ACS) and by diseased vessels (organic stenosis). Covariance structure analysis was simultaneously performed in one equation model for determination and comparison of the risk factors for organic stenosis and ACS.ResultsThe analysis revealed that age (standardized regression coefficient, β: 0.206, P < 0.001), male gender (β: 0.126, P < 0.001), HbA1c level (β: 0.109, P < 0.001), HDL level (β: -0.109, P < 0.001) and LDL level (β: 0.127, P = 0.002) were significant for the advancement of organic stenosis. HDL level (β: 0100, P = 0.002) and MDA-LDL level (β: 0.335, P < 0.001) were significant for the onset of ACS, but age, HbA1c and LDL (P = NS or β < 0.1, respectively) were not. Among the risk factors, age, HbA1c and LDL were significantly more strongly associated with organic stenosis than ACS, while MDA-LDL was significantly more strongly associated with ACS than organic stenosis.ConclusionsThe current statistical analysis revealed clear differences among the risk factors between the progression of organic stenosis and the onset of ACS. Among them, the MDA-LDL level should be considered to indicate a substantial risk of ACS.

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Potent influence of obesity on suppression of plasma B-type natriuretic peptide levels in patients with acute heart failure: An approach using covariance structure analysis

Abstract: The low plasma BNP levels in true obesity patients with acute heart failure are of concern, because plasma BNP cannot increase in such patients.

Cited by 20 publications

References 27 publications

Possible increase in insulin resistance and concealed glucose-coupled potassium-lowering mechanisms during acute coronary syndrome documented by covariance structure analysis

Possible increase in insulin resistance and concealed glucose-coupled potassium-lowering mechanisms during acute coronary syndrome documented by covariance structure analysis

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

Parallel comparison of risk factors between progression of organic stenosis in the coronary arteries and onset of acute coronary syndrome by covariance structure analysis

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