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Body Mass Index, Natriuretic Peptides, and Risk of Adverse Outcomes in Patients With Heart Failure and Preserved

Ambarish Pandey1, Jarett D Berry1, Mark H Drazner1

  • 11 Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.

Journal of the American Heart Association
|November 1, 2018
PubMed

Insights

Natriuretic peptide levels and body mass index interact in heart failure with preserved ejection fraction. High natriuretic peptide levels increase mortality risk, especially in obese patients.

Area of Science:

  • Cardiology
  • Biomarkers
  • Heart Failure Research

Background:

  • The prognostic relationship between natriuretic peptide (NP) levels and body mass index (BMI) in chronic stable heart failure with preserved ejection fraction (HFpEF) is not well understood.
  • Existing research has not fully characterized this interrelationship, limiting clinical risk stratification.

Purpose of the Study:

  • To investigate the prognostic association between natriuretic peptide levels and body mass index in patients with chronic stable heart failure with preserved ejection fraction.
  • To determine how combined BMI and NP levels predict adverse clinical outcomes, including heart failure hospitalization and all-cause mortality.

Main Methods:

  • Analysis of 997 participants from the TOPCAT trial (Americas cohort).
  • Stratification into four BMI/NP categories based on data-derived BMI and standardized NP-z scores.
  • Utilized adjusted Cox-proportional models to assess associations with primary endpoint, heart failure hospitalization, and mortality.

Main Results:

  • A U-shaped relationship was observed between BMI and NP levels, with higher NP at BMI extremes.
  • BMI showed a U-shaped association with adverse outcomes, with lowest risk around BMI 25 kg/m².
  • Higher NP levels were linearly associated with increased risk of adverse outcomes.
  • The high BMI/high NP group exhibited more cardiac abnormalities and the highest risk of adverse outcomes (HR for primary endpoint: 2.29 [1.36-3.84] vs. low BMI/low NP).

Conclusions:

  • A U-shaped association exists between BMI and NP levels in HFpEF patients.
  • Elevated NP levels independently predict higher mortality risk across all BMI strata.
  • In obese HFpEF patients, high NP levels identify a high-risk phenotype with increased mortality and hospitalization rates.

Keywords:
brain natriuretic peptideheart failureobesity

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