Circulation. 2004;109:594-600
doi: 10.1161/01.CIR.0000112582.16683.EA
doi: 10.1161/01.CIR.0000112582.16683.EA
(Circulation. 2004;109:594-600.)
© 2004 American Heart Association, Inc.
Clinical Investigation and Reports |
Impact of Obesity on Plasma Natriuretic Peptide Levels
From the Framingham Heart Study, Framingham, Mass; Cardiology Division (T.J.W.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass; National Heart, Lung & Blood Institute (D.L.), Bethesda, Md; and Sections of Cardiology (D.L., E.J.B., R.S.V.) and Preventive Medicine (D.L., E.J.B., P.W.F.W., R.S.V.), Boston Medical Center, Boston University School of Medicine, Boston, Mass.
Correspondence to Ramachandran S. Vasan, MD, Framingham Heart Study, 73 Mt Wayte Ave, #2, Framingham, MA 01702. E-mail vasan{at}fram.nhlbi.nih.gov
Received August 12, 2003; revision received November 11, 2003; accepted November 14, 2003.
Background— The mechanisms linking obesity to hypertension have not been established, but sodium retention and excessive sympathetic tone are key contributors. The natriuretic peptides are important regulators of sodium homeostasis and neurohormonal activation, raising the possibility that obese individuals have an impaired natriuretic peptide response.
Methods and Results— We examined the relations of plasma B-type natriuretic peptide (BNP) and N-terminal proatrial natriuretic peptide (N-ANP) to body mass index in 3389 Framingham Study participants (1803 women) without heart failure. Multivariable regression analyses were performed, adjusting for clinical and echocardiographic covariates. BNP levels below the assay detection limit and N-ANP levels in the lowest sex-specific quartile were categorized as low. Multivariable-adjusted mean plasma BNP levels in lean (<25 kg/m2), overweight (25 to 29.9 kg/m2), and obese (
30 kg/m2) men were 21.4, 15.5, and 12.7 pg/mL, respectively (trend P<0.0001). Corresponding values in women were 21.1, 16.3, and 13.1 pg/mL (trend P<0.001). A similar pattern was noted for plasma N-ANP. Obese individuals had higher odds of having low plasma BNP (multivariable-adjusted odds ratios: men, 2.51; 95% CI, 1.71 to 3.68; women, 1.84; 95% CI, 1.32 to 2.58) and low plasma N-ANP (odds ratios: men, 4.81; 95% CI, 2.98 to 7.76; women, 2.85; 95% CI, 2.01 to 4.04) compared with lean individuals. Diabetes also was associated with low plasma natriuretic peptide levels, and the negative effects of obesity and diabetes on natriuretic peptide levels were additive.
Conclusions— Obese individuals have low circulating natriuretic peptide levels, which may contribute to their susceptibility to hypertension and hypertension-related disorders.
Key Words: natriuretic peptides • obesity • epidemiology
This article has been cited by other articles:
 |
|
 |
|
  L Ingle, J G F Cleland, and A L Clark Perception of symptoms is out of proportion to cardiac pathology in patients with "diastolic heart failure" Heart, June 1, 2008; 94(6): 748 - 753. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Lancellotti, B. Cosyns, and L. A. Pierard Dynamic left ventricular dyssynchrony contributes to B-type natriuretic peptide release during exercise in patients with systolic heart failure Europace, April 1, 2008; 10(4): 496 - 501. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. O. Belo, M. R. Sairam, and A. M. dos Reis Impairment of the Natriuretic Peptide System in Follitropin Receptor Knockout Mice and Reversal by Estradiol: Implications for Obesity-Associated Hypertension in Menopause Endocrinology, March 1, 2008; 149(3): 1399 - 1406. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Paniagua, D. Amato, S. Mujais, E. Vonesh, A. Ramos, R. Correa-Rotter, and W. H. Horl Predictive Value of Brain Natriuretic Peptides in Patients on Peritoneal Dialysis: Results from the ADEMEX Trial Clin. J. Am. Soc. Nephrol., March 1, 2008; 3(2): 407 - 415. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. B. Daniels and A. S. Maisel Natriuretic Peptides J. Am. Coll. Cardiol., December 18, 2007; 50(25): 2357 - 2368. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Codognotto, A. Piccoli, M. Zaninotto, M. Mion, M. Plebani, U. Vertolli, F. Tona, L. Ruzza, A. Barchita, and G. M. Boffa Renal Dysfunction Is a Confounder for Plasma Natriuretic Peptides in Detecting Heart Dysfunction in Uremic and Idiopathic Dilated Cardiomyopathies Clin. Chem., December 1, 2007; 53(12): 2097 - 2104. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Kenchaiah, S. J. Pocock, D. Wang, P. V. Finn, L. A.M. Zornoff, H. Skali, M. A. Pfeffer, S. Yusuf, K. Swedberg, E. L. Michelson, et al. Body Mass Index and Prognosis in Patients With Chronic Heart Failure: Insights From the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) Program Circulation, August 7, 2007; 116(6): 627 - 636. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Breidthardt, K. Laule, A.-H. Strohmeyer, C. Schindler, S. Meier, M. Fischer, A. Scholer, M. Noveanu, M. Christ, A. P. Perruchoud, et al. Medical and Economic Long-term Effects of B-Type Natriuretic Peptide Testing in Patients with Acute Dyspnea Clin. Chem., August 1, 2007; 53(8): 1415 - 1422. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W.H. Wilson Tang, G. S. Francis, D. A. Morrow, L. K. Newby, C. P. Cannon, R. L. Jesse, A. B. Storrow, R. H. Christenson, COMMITTEE MEMBERS, R. H. Christenson, et al. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Clinical Utilization of Cardiac Biomarker Testing in Heart Failure Circulation, July 31, 2007; 116(5): e99 - e109. [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Richards Natriuretic Peptides: Update on Peptide Release, Bioactivity, and Clinical Use Hypertension, July 1, 2007; 50(1): 25 - 30. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Meirhaeghe, M. S. Sandhu, M. I. McCarthy, P. de Groote, D. Cottel, D. Arveiler, J. Ferrieres, C. J. Groves, A. T. Hattersley, G. A. Hitman, et al. Association between the T-381C polymorphism of the brain natriuretic peptide gene and risk of type 2 diabetes in human populations Hum. Mol. Genet., June 1, 2007; 16(11): 1343 - 1350. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Aoyagi, J.-i. Birumachi, M. Hiroyama, Y. Fujiwara, A. Sanbe, J. Yamauchi, and A. Tanoue Alteration of Glucose Homeostasis in V1a Vasopressin Receptor-Deficient Mice Endocrinology, May 1, 2007; 148(5): 2075 - 2084. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Musunuru, R. S. Blumenthal, P. M Ridker, N. R. Cook, D. M. Becker, S. Mora, D. C. Goff Jr., R. H. Fletcher, S. W. Fletcher, G. Mints, et al. Biomarkers for Prediction of Cardiovascular Events N. Engl. J. Med., April 5, 2007; 356(14): 1472 - 1475. [Full Text] [PDF]
|
|
|
|
|
|
T. J. Wang, M. G. Larson, M. J. Keyes, D. Levy, E. J. Benjamin, and R. S. Vasan Association of Plasma Natriuretic Peptide Levels With Metabolic Risk Factors in Ambulatory Individuals Circulation, March 20, 2007; 115(11): 1345 - 1353. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Bayes-Genis, D. M. Lloyd-Jones, R. R. J. van Kimmenade, J. G. Lainchbury, A. M. Richards, J. Ordonez-Llanos, M. Santalo, Y. M. Pinto, and J. L. Januzzi Jr Effect of Body Mass Index on Diagnostic and Prognostic Usefulness of Amino-Terminal Pro-Brain Natriuretic Peptide in Patients With Acute Dyspnea Arch Intern Med, February 26, 2007; 167(4): 400 - 407. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Y. Chang, S. M. Abdullah, T. Jain, H. G. Stanek, S. R. Das, D. K. McGuire, R. J. Auchus, and J. A. de Lemos Associations Among Androgens, Estrogens, and Natriuretic Peptides in Young Women: Observations From the Dallas Heart Study J. Am. Coll. Cardiol., November 7, 2006; (2006) j.jacc.2006.10.040v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. J. Shelton, A. L. Clark, K. Goode, A. S. Rigby, and J. G.F. Cleland The diagnostic utility of N-terminal pro-B-type natriuretic peptide for the detection of major structural heart disease in patients with atrial fibrillation Eur. Heart J., October 1, 2006; 27(19): 2353 - 2361. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. M. Felker, J. W. Petersen, and D. B. Mark Natriuretic peptides in the diagnosis and management of heart failure. Can. Med. Assoc. J., September 12, 2006; 175(6): 611 - 617. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. H. Chen and J. C. Burnett Jr Clinical application of the natriuretic peptides in heart failure Eur. Heart J. Suppl., September 1, 2006; 8(suppl_E): E18 - E25. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Kragelund, I. Gustafsson, T. Omland, B. Gronning, L. Kober, J. Faber, S. Strande, R. Steffensen, and P. Hildebrandt Prognostic Value of NH2-Terminal Pro B-Type Natriuretic Peptide in Patients With Diabetes and Stable Coronary Heart Disease. Diabetes Care, June 1, 2006; 29(6): 1411 - 1413. [Full Text] [PDF]
|
|
|
|
|
|
C. Mueller, K. Laule-Kilian, C. Schindler, T. Klima, B. Frana, D. Rodriguez, A. Scholer, M. Christ, and A. P. Perruchoud Cost-effectiveness of B-Type Natriuretic Peptide Testing in Patients With Acute Dyspnea. Arch Intern Med, May 22, 2006; 166(10): 1081 - 1087. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. V. St. Peter, G. G. Hartley, M. M. Murakami, and F. S. Apple B-Type Natriuretic Peptide (BNP) and N-Terminal Pro-BNP in Obese Patients without Heart Failure: Relationship to Body Mass Index and Gastric Bypass Surgery Clin. Chem., April 1, 2006; 52(4): 680 - 685. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. van Kimmenade, F. van Dielen, J. Bakker, J. Nijhuis, H. Crijns, W. Buurman, M. van Dieijen-Visser, J.-W. Greve, and Y. Pinto Is Brain Natriuretic Peptide Production Decreased in Obese Subjects? J. Am. Coll. Cardiol., February 21, 2006; 47(4): 886 - 887. [Full Text] [PDF]
|
|
|
|
 |
|
 T. Nishikimi, N. Maeda, and H. Matsuoka The role of natriuretic peptides in cardioprotection Cardiovasc Res, February 1, 2006; 69(2): 318 - 328. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. C. Costello-Boerrigter, G. Boerrigter, M. M. Redfield, R. J. Rodeheffer, L. H. Urban, D. W. Mahoney, S. J. Jacobsen, D. M. Heublein, and J. C. Burnett Jr Amino-Terminal Pro-B-Type Natriuretic Peptide and B-Type Natriuretic Peptide in the General Community: Determinants and Detection of Left Ventricular Dysfunction J. Am. Coll. Cardiol., January 17, 2006; 47(2): 345 - 353. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. B. Horwich, M. A. Hamilton, and G. C. Fonarow B-Type Natriuretic Peptide Levels in Obese Patients With Advanced Heart Failure J. Am. Coll. Cardiol., January 3, 2006; 47(1): 85 - 90. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Talens-Visconti, M. Rivera Otero, M. J. Sancho-Tello, F. G. de Burgos, L. Martinez-Dolz, B. Sevilla, V. Climent, R. Cortes, A. Salvador, F. Sogorb, et al. Left ventricular cavity area reflects N-terminal pro-brain natriuretic peptide plasma levels in heart failure Eur J Echocardiogr, January 1, 2006; 7(1): 45 - 52. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Clerico, F. A. Recchia, C. Passino, and M. Emdin Cardiac endocrine function is an essential component of the homeostatic regulation network: physiological and clinical implications Am J Physiol Heart Circ Physiol, January 1, 2006; 290(1): H17 - H29. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Schou, M. K. Dalsgaard, O. Clemmesen, E. A. Dawson, C. C. Yoshiga, H. B. Nielsen, F. Gustafsson, P. R. Hildebrandt, and N. H. Secher Kidneys extract BNP and NT-proBNP in healthy young men J Appl Physiol, November 1, 2005; 99(5): 1676 - 1680. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. R. Das, M. H. Drazner, D. L. Dries, G. L. Vega, H. G. Stanek, S. M. Abdullah, R. M. Canham, A. K. Chung, D. Leonard, F. H. Wians Jr, et al. Impact of Body Mass and Body Composition on Circulating Levels of Natriuretic Peptides: Results From the Dallas Heart Study Circulation, October 4, 2005; 112(14): 2163 - 2168. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Lafontan, C. Moro, C. Sengenes, J. Galitzky, F. Crampes, and M. Berlan An Unsuspected Metabolic Role for Atrial Natriuretic Peptides: The Control of Lipolysis, Lipid Mobilization, and Systemic Nonesterified Fatty Acids Levels in Humans Arterioscler. Thromb. Vasc. Biol., October 1, 2005; 25(10): 2032 - 2042. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. H. Olsen, T. W. Hansen, M. K. Christensen, F. Gustafsson, S. Rasmussen, K. Wachtell, K. Borch-Johnsen, H. Ibsen, T. Jorgensen, and P. Hildebrandt N-Terminal Pro Brain Natriuretic Peptide Is Inversely Related to Metabolic Cardiovascular Risk Factors and the Metabolic Syndrome Hypertension, October 1, 2005; 46(4): 660 - 666. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Developed in Collaboration With the American Colle, Endorsed by the Heart Rhythm Society, S. A. Hunt, W. T. Abraham, M. H. Chin, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. Jessup, M. A. Konstam, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure) J. Am. Coll. Cardiol., September 20, 2005; 46(6): 1116 - 1143. [Full Text] [PDF]
|
|
|
|
|
|
S. A. Hunt, W. T. Abraham, M. H. Chin, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. Jessup, M. A. Konstam, D. M. Mancini, K. Michl, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): Developed in Collaboration With the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: Endorsed by the Heart Rhythm Society Circulation, September 20, 2005; 112(12): 1825 - 1852. [Full Text] [PDF]
|
|
|
|
|
|
C. W. Knudsen, T. Omland, P. Clopton, A. Westheim, A. H.B. Wu, P. Duc, J. McCord, R. M. Nowak, J. E. Hollander, A. B. Storrow, et al. Impact of Atrial Fibrillation on the Diagnostic Performance of B-Type Natriuretic Peptide Concentration in Dyspneic Patients: An Analysis From the Breathing Not Properly Multinational Study J. Am. Coll. Cardiol., September 6, 2005; 46(5): 838 - 844. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. J. Zieman, V. Melenovsky, and D. A. Kass Mechanisms, Pathophysiology, and Therapy of Arterial Stiffness Arterioscler. Thromb. Vasc. Biol., May 1, 2005; 25(5): 932 - 943. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K.-M. Hermann-Arnhof, U. Hanusch-Enserer, T. Kaestenbauer, T. Publig, A. Dunky, H. R. Rosen, R. Prager, and U. Koller N-Terminal Pro-B-Type Natriuretic Peptide as an Indicator of Possible Cardiovascular Disease in Severely Obese Individuals: Comparison with Patients in Different Stages of Heart Failure Clin. Chem., January 1, 2005; 51(1): 138 - 143. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Minami, T. Nishikimi, H. Matsuoka, T. J. Wang, M. G. Larson, D. Levy, E. J. Benjamin, E. P. Leip, P. W.F. Wilson, and R. S. Vasan Plasma Brain Natriuretic Peptide and N-Terminal Proatrial Natriuretic Peptide Levels in Obese Patients: A Cause or Result of Hypertension? Circulation, August 17, 2004; 110(7): e76 - e76. [Full Text] [PDF]
|
|