The associations between metabolic variables and NT-proBNP are blunted at pathological ranges: The Multi-Ethnic Study of Atherosclerosis

Sánchez, Otto A.; Duprez, Daniel; Bahrami, Hossein; Daniels, Lori B.; Folsom, Aaron R.; Lima, João A.C.; Maisel, Alan S.; Peralta, Carmen A.; Jacobs, David R.

doi:10.1016/j.metabol.2013.11.017

Cited by 46 publications

(66 citation statements)

References 49 publications

(48 reference statements)

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“…Several previous studies showed important associations between N‐terminal pro B‐type natriuretic peptide and incident HF,46 atrial fibrillation,47 and subclinical cardiovascular disease 48. Ndumele et al demonstrated that N‐terminal pro B‐type natriuretic peptide is a strong predictor of incident HF in individuals with and without obesity 46.…”

Section: Discussionmentioning

confidence: 98%

Fibroblast Growth Factor‐23 and Heart Failure With Reduced Versus Preserved Ejection Fraction: MESA

Almahmoud

Soliman

Bertoni

et al. 2018

JAHA

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BackgroundHigher fibroblast growth factor‐23 (FGF‐23) levels are associated with incident heart failure (HF) in MESA (the Multiethnic Study of Atherosclerosis). FGF‐23 is also associated with left ventricular hypertrophy. Whether the FGF‐23 association with HF is similar for heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) is not well established.Methods and ResultsWe studied 6542 participants (mean age 62±10 years, 53% women, mean estimated glomerular filtration rate of 81±18 mL/min per 73 m2) from MESA who were free of cardiovascular disease at baseline (2000–2002). HF events were ascertained by an adjudication committee for a median follow‐up of 12.1 years. We classified HF events as HFrEF (ejection fraction [EF] <50%) or HFpEF [EF] ≥50%) at the time of diagnosis. Cox proportional hazard regression was used to compute hazard ratios and 95% confidence intervals for the association between baseline serum FGF‐23 and incident HFrEF and HFpEF. A total of 134 events were classified as HFpEF, 151 HFrEF, and 49 unknown EF. Following imputation, 149 were classified as HFpEF, 176 HFrEF, and 291 participants had HF (34 participants had HFpEF then HFrEF). In the fully adjusted model, higher FGF‐23 levels were associated with incident HFpEF but not with HFrEF (hazard ratio 1.29, 95% confidence interval, 1.08–1.54) versus (hazard ratio 1.04, 95% confidence interval, 0.84–1.29) for each 20 pg/mL higher serum FGF‐23 concentration.Conclusions FGF‐23 association with HF is driven by the association with HFpEF but not with HFrEF in a population‐based cohort. Further studies are needed to determine the pathological mechanisms mediating this association.

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Section: Discussionmentioning

confidence: 98%

Fibroblast Growth Factor‐23 and Heart Failure With Reduced Versus Preserved Ejection Fraction: MESA

Almahmoud

Soliman

Bertoni

et al. 2018

JAHA

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“…The association between blood lipids concentrations and glucose with NT-proBNP does not follow a linear association throughout the whole range of NT-proBNP values [7]. For NT-proBNP levels <100 pg/mL, we suggested that variations in NT-proBNP occur in response to physiological events.…”

Section: Introductionmentioning

confidence: 87%

“…Plasma NT-proBNP was measured at the Veterans Affairs San Diego Health Care System, using an ElecSys 2010 analyzer (Roche Diagnostics, Indianapolis, IN) [10,11]. Interleukin-6 (IL-6) was measured as previously described [7]. Lipoprotein particle concentration was determined at LipoScience, Inc. (Raleigh, NC) by nuclear magnetic resonance spectroscopy using the LipoProfile-3 algorithm.…”

Section: Methodsmentioning

confidence: 99%

“…For NT-proBNP levels <100 pg/mL, we suggested that variations in NT-proBNP occur in response to physiological events. However, within the range in which pathophysiology presumably plays a primary role in determining BNP levels (≥100 pg/mL) the influence of pathological factors (subclinical CVD and inflammation) becomes progressively more important leading to substantial elevations in NT-proBNP and blunting of the physiological effects of natriuretic peptides on lipid metabolism [7]. …”

Section: Introductionmentioning

confidence: 99%

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The association between N-terminal pro B-type natriuretic peptide and lipoprotein particle concentration plateaus at higher N-terminal pro B-type natriuretic peptide values: Multi-Ethnic Study on Atherosclerosis

et al. 2015

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Background The association between N-terminal pro B-type natriuretic peptide (NT-proBNP) and blood levels of small and large LDL- and HDL- particle (P) concentration may not be linear throughout the whole range of NT-proBNP values. Methods Linear spline regression analysis between NT-proBNP and lipoprotein particle concentrations was performed cross-sectionally in 5597 individuals from the Multi-Ethnic Study of Atherosclerosis adjusted for age, race, sex, body mass index, % of energy from saturated fats, intentional exercise, statin use, antihypertensive medication use, diabetes, IL-6 and estimated glomerular filtration rate. Spline knots were selected as the point at which the linear slope changed in these associations. Results NT-proBNP was positively associated with large LDL-P and HDL-P, but inversely associated with small LDL-P and HDL-P, but only for NT-proBNP values below the knot (range: 100–200 pg/mL). Conclusion These results suggest the presence of two distinct biological mechanisms above and below the knot determining the association between NT-proBNP and lipoprotein particle concentrations.

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“…On the contrary, in diabetic patients an increase in BNP and NT-proBNP levels may reflect proBNP accumulation that masks the linear relationship between residual active BNP and metabolic parameters, but being the result of altered cardiac processing is a valuable biomarker of early cardiac and hemodynamic abnormalities and of the inability of the heart to effectively counteract them by enhancing active BNP production. In keeping with this scenario, recent data from the Multi-Ethnic Study of Atherosclerosis (MESA) (81) have shown that when subclinical CVD develops and NT-proBNP levels rise, the inverse relationship between NT-proBNP and both BMI and insulin resistance is completely lost.…”

Section: Diabetes Complicationsmentioning

confidence: 97%

Natriuretic Peptides, Heart, and Adipose Tissue: New Findings and Future Developments for Diabetes Research

2014

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Natriuretic peptides (NPs) play a key role in cardiovascular homeostasis, counteracting the deleterious effects of volume and pressure overload and activating antibrotic and antihypertrophic pathways in the heart. N-terminal B-type NP (NT-proBNP) also is a promising biomarker of global cardiovascular risk in the general population, and there is increasing interest on its potential use in diabetic patients for screening of silent cardiovascular abnormalities, cardiovascular risk stratification, and guided intervention. Recently, both atrial NP (ANP) and B-type NP (BNP) have emerged as key mediators in the control of metabolic processes including the heart in the network of organs that regulate energy usage and metabolism. Epidemiological studies have shown that ANP and BNP are reduced in people with obesity, insulin resistance, and diabetes, and this deficiency may contribute to enhance their global cardiovascular risk. Moreover, ANP and BNP have receptors in the adipose tissue, enhance lipolysis and energy expenditure, and modulate adipokine release and food intake. Therefore, low ANP and BNP levels may be not only a consequence but also a cause of obesity, and recent prospective studies have shown that low levels of NT-proBNP and midregional proANP (MR-proANP) are a strong predictor of type 2 diabetes onset. Whether ANP and BNP supplementation may result in either cardiovascular or metabolic benefits in humans remains, however, to be established.Natriuretic peptides (NPs) have gained great interest as indicators of the state of cardiovascular health across the spectrum of cardiovascular diseases (CVD) in diabetic subjects (1-4). Recently, NPs also have emerged as key mediators in the control of metabolic processes (5) and have been implicated in the development of diabetes (6,7), shifting current paradigms and opening novel avenues in diabetes research. This review will summarize new findings in the field and discuss their potential clinical relevance. NPS AND THEIR RECEPTORSNPs are a family of genetically distinct and structurally related peptides, including atrial NP (ANP), B-type NP (BNP), and C-type NP (CNP). They share a similar structural conformation, characterized by a peptide ring with a cysteine bridge, which is well preserved throughout evolution, being the portion of the chain that binds to the receptor. ANP and BNP are predominantly secreted by cardiomyocytes, whereas CNP is mainly produced by the central nervous system, the endothelium, the bone, and the reproductive system (8-11).

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The associations between metabolic variables and NT-proBNP are blunted at pathological ranges: The Multi-Ethnic Study of Atherosclerosis

Cited by 46 publications

References 49 publications

Fibroblast Growth Factor‐23 and Heart Failure With Reduced Versus Preserved Ejection Fraction: MESA

Fibroblast Growth Factor‐23 and Heart Failure With Reduced Versus Preserved Ejection Fraction: MESA

The association between N-terminal pro B-type natriuretic peptide and lipoprotein particle concentration plateaus at higher N-terminal pro B-type natriuretic peptide values: Multi-Ethnic Study on Atherosclerosis

Natriuretic Peptides, Heart, and Adipose Tissue: New Findings and Future Developments for Diabetes Research

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