016 N-terminal pro-brain natriuretic peptide levels and obesity in patients with acute myocardial infarction. Data from the RICO survey

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• 作者：Luc Lorgis¹ ; Yves Cottin¹ ; Pierre Sicard² ; Philippe Buffet¹ ; Alexandre Cochet³ ; Jean Claude Beer¹ ; Isabelle L&rsquo ; Huillier¹ ; Michel Vincent-Martin⁴ ; Hamid Makki⁵ ; Philippe Gambert⁶ ; Marianne Zeller⁷
• 刊名：Archives of Cardiovascular Diseases Supplements
• 出版年：2010
• 出版时间：January 2010
• 年：2010
• 卷：2
• 期：1
• 页码：5-6
• 全文大小：115 K

文摘

Objective

Recent findings reported intriguing relationships between obesity and natriuretic peptides. In patients with acute myocardial infarction (MI), we aimed to investigate the relation between body mass index (BMI) and N-Terminal pro Brain Natriuretic Peptide (NT-proBNP) level.

Patients and methods

From a French regional survey for acute MI, we formed 739 triplets of patients (n=2217) with an acute MI, matched with respect to age, gender, and renal function (MDRD, modification of diet in renal disease), each classified for BMI groups as obese (BMI> 30 kg/m²), overweight (BMI 25-29.9 kg/m²) and normal (BMI 20-24.9 kg/m²). Blood samples were taken on admission to assess NT-proBNP levels.

Results

Among the 2217 participants, mean age was 68¡À12 years, 80 % were male and MDRD was 75¡À26 ml/min/1.73m_. Higher prevalence of CV risk factors (hypertension, diabetes and dyslipidemia) was found across the overweight and obese groups. Admission CRP levels were increased in obese patients. Clinical heart failure on admission and LVEF were similar for the 3 groups. When compared with normal BMI, levels of NT-proBNP dramatically decreased by about 20 % in overweight and by 60 % in obese patients (1046 vs 839 and 444 pg/ml, respectively, p<0.001). An inverse relationship between the propeptide values and BMI was found (r=-0.20, p<0.0001). By multivariable linear regression, BMI was a predictor of logNT-proBNP level. One-Y CV mortality was similar for the 3 BMI groups (p=0.691). By multivariate logistic regression analysis, logNT-proBNP independently predicted 1-Y CV mortality in normal (OR(95 % CI), 2.24(1.29-3.89)) and overweight (OR(95 % CI): 6.11(2.75-13.60)) patients. However, in obese patients, the propeptide levels failed to retain its prognostic capacity (OR (95 % CI): 1.44(0.88-2.35)).

Conclusions

In this large contemporary non-selected cohort of MI patients, NT-proBNP levels were dramatically reduced in obese patients even matched for age, renal function and gender. Moreover, in obese patients with acute MI, the significance of the propeptide level as an independent prognostic factor remains to be determined.