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J Am Coll Cardiol, 2004; 43:1590-1595, doi:10.1016/j.jacc.2003.10.066
© 2004 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: BNP AND HEART FAILURE

Obesity and suppressed B-type natriuretic peptide levels in heart failure

Mandeep R. Mehra, MD, FACC*,*, Patricia A. Uber, PharmD*, Myung H. Park, MD*, Robert L. Scott, MD*, Hector O. Ventura, MD, FACC*, Bobbett C. Harris, RN* and Edward D. Frohlich, MD, FACC*

* Department of Cardiovascular Medicine, Ochsner Clinic Foundation, New Orleans, Louisiana, USA

Manuscript received July 24, 2003; revised manuscript received October 6, 2003, accepted October 7, 2003.

* Reprint requests and correspondence: Dr. Mandeep R. Mehra, 1514 Jefferson Highway, New Orleans, Louisiana 70121, USA.
mmehra{at}ochsner.org

OBJECTIVES: This investigation evaluated the relationship between obesity and B-type natriuretic peptide (BNP) in heart failure.

BACKGROUND: Obesity is a major risk factor for the development of heart failure, but the precise mechanisms remain uncertain. Physiologically, natriuretic peptides and lipolysis are closely linked.

METHODS: A total of 318 patients with heart failure were evaluated between June 2001 and June 2002. Levels of BNP were compared in obese (body mass index [BMI] ≥30 kg/m2) and nonobese (BMI <30 kg/m2) patients with respect to New York Heart Association functional class and lean body weight–adjusted peak aerobic oxygen consumption. In a subset of 36 patients, plasma levels of tumor necrosis factor-alpha, interleukin-6, and soluble intercellular adhesion molecule-1 were measured.

RESULTS: The population's BMI was 29.4 ± 6.6 kg/m2; 24% were lean (BMI <25 kg/m2), 31% overweight (BMI ≥25 to 29.9 kg/m2), and 45% obese (BMI ≥30 kg/m2). Obese patients were younger, more often African American, and more likely to have a history of antecedent hypertension, but less likely to have coronary artery disease and with only a trend toward diabetes mellitus. Levels of BNP were significantly lower in obese than in nonobese subjects (205 ± 22 and 335 ± 39 pg/ml, respectively; p = 0.0007), despite a similar severity of heart failure and cytokine levels. Multivariate regression analysis identified BMI as an independent negative correlate of BNP level. There were no differences in emergency department visits, heart failure hospitalization, or death between the obese and nonobese patients at 12-month follow-up.

CONCLUSIONS: Our investigation indicates that a state of reduced natriuretic peptide level exists in the obese individual with heart failure.

Abbreviations and Acronyms
  BMI = body mass index
  BNP = B-type natriuretic peptide
  CHF = chronic heart failure
  CI = confidence interval
  CPX = cardiopulmonary stress testing
  LV = left ventricular
  LVEF = left ventricular ejection fraction
  NYHA = New York Heart Association
  VO2 = oxygen consumption




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