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
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