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Masuch A, Pietzner M, Bahls M, Budde K, Kastenmüller G, Zylla S, Artati A, Adamski J, Völzke H, Dörr M, Felix SB, Nauck M, Friedrich N. Metabolomic profiling implicates adiponectin as mediator of a favorable lipoprotein profile associated with NT-proBNP. Cardiovasc Diabetol 2018; 17:120. [PMID: 30153838 PMCID: PMC6112131 DOI: 10.1186/s12933-018-0765-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/23/2018] [Indexed: 12/11/2022] Open
Abstract
Background The N-terminal prohormone of brain natriuretic peptide (NT-proBNP) is an important biomarker for the diagnosis of heart failure. Apart from this and only recently recognized, NT-proBNP levels associate with higher HDL- and lower LDL-cholesterol levels comprising a favorable blood lipid profile. To further examine this observation, the lipoprotein profile in relation to NT-proBNP was examined in-depth by proton nuclear magnetic resonance spectroscopy (1H-NMR). We complemented this investigation with a state-of-the-art untargeted metabolomics approach. Methods Lipoprotein particles were determined by 1H-NMR spectroscopy in 872 subjects without self-reported diabetes from the population-based Study of Health in Pomerania (SHIP)-TREND with available NT-proBNP measurements. Comprehensive metabolomics data for plasma and urine samples were obtained. Linear regression models were performed to assess the associations between serum concentrations of NT-proBNP and the metabolites/lipoprotein particles measured in plasma or urine. Results An increase in serum NT-proBNP was associated with a benefical lipoprotein profile, including a decrease in VLDL, IDL and LDL-particles along with an increase in large HDL particles. These findings were replicated in a second independent cohort. Serum concentrations of NT-proBNP showed significant inverse associations with seven plasma metabolites while associations with 39 urinary metabolites, mostly comprising amino acids and related intermediates, were identified. Mediation analyses revealed adiponection as mediating factor for the associations observed with lipoproteins particles. Conclusions Most of the metabolic changes associated with NT-proBNP implicate significant influence on the blood lipid profile besides vasodilatory and the diuretic action of BNP signaling. Our data suggest that the more favorable lipoprotein profile as associated with elevated NT-proBNP concentrations in mainly cardiac healthy individuals might relate to adiponectin signaling indicating even indirect cardio-protective effects for NT-proBNP. Electronic supplementary material The online version of this article (10.1186/s12933-018-0765-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annette Masuch
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany.
| | - Maik Pietzner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany.,German Center for Cardiovascular Research (DZHK e.V.), Partner Site Greifswald, Greifswald, Germany
| | - Martin Bahls
- German Center for Cardiovascular Research (DZHK e.V.), Partner Site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Kathrin Budde
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany.,German Center for Cardiovascular Research (DZHK e.V.), Partner Site Greifswald, Greifswald, Germany
| | - Gabi Kastenmüller
- Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Stephanie Zylla
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany.,German Center for Cardiovascular Research (DZHK e.V.), Partner Site Greifswald, Greifswald, Germany
| | - Anna Artati
- Institute of Experimental Genetics, Genome Analysis Center, Helmholtz Zentrum München, Neuherberg, Germany
| | - Jerzy Adamski
- Institute of Experimental Genetics, Genome Analysis Center, Helmholtz Zentrum München, Neuherberg, Germany.,Lehrstuhl für Experimentelle Genetik, Technische Universität München, Freising-Weihenstephan, Germany.,DZD (German Center for Diabetes Research), München-Neuherberg, Germany
| | - Henry Völzke
- German Center for Cardiovascular Research (DZHK e.V.), Partner Site Greifswald, Greifswald, Germany.,Institute for Community Medicine, University Medicine Greifswald, Greifswald, 17475, Germany.,DZD (German Center for Diabetes Research), Site Greifswald, Greifswald, 17475, Germany
| | - Marcus Dörr
- German Center for Cardiovascular Research (DZHK e.V.), Partner Site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Stephan B Felix
- German Center for Cardiovascular Research (DZHK e.V.), Partner Site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany.,German Center for Cardiovascular Research (DZHK e.V.), Partner Site Greifswald, Greifswald, Germany
| | - Nele Friedrich
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany.,German Center for Cardiovascular Research (DZHK e.V.), Partner Site Greifswald, Greifswald, Germany
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Blaha MJ, Cainzos-Achirica M, Greenland P, McEvoy JW, Blankstein R, Budoff MJ, Dardari Z, Sibley CT, Burke GL, Kronmal RA, Szklo M, Blumenthal RS, Nasir K. Role of Coronary Artery Calcium Score of Zero and Other Negative Risk Markers for Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis (MESA). Circulation 2016; 133:849-58. [PMID: 26801055 PMCID: PMC4775391 DOI: 10.1161/circulationaha.115.018524] [Citation(s) in RCA: 328] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 01/14/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited attention has been paid to negative cardiovascular disease (CVD) risk markers despite their potential to improve medical decision making. We compared 13 negative risk markers using diagnostic likelihood ratios (DLRs), which model the change in risk for an individual after the result of an additional test. METHODS AND RESULTS We examined 6814 participants from the Multi-Ethnic Study of Atherosclerosis. Coronary artery calcium score of 0, carotid intima-media thickness <25th percentile, absence of carotid plaque, brachial flow-mediated dilation >5% change, ankle-brachial index >0.9 and <1.3, high-sensitivity C-reactive protein <2 mg/L, homocysteine <10 µmol/L, N-terminal pro-brain natriuretic peptide <100 pg/mL, no microalbuminuria, no family history of coronary heart disease (any/premature), absence of metabolic syndrome, and healthy lifestyle were compared for all and hard coronary heart disease and all CVD events over the 10-year follow-up. Models were adjusted for traditional CVD risk factors. Among all negative risk markers, coronary artery calcium score of 0 was the strongest, with an adjusted mean DLR of 0.41 (SD, 0.12) for all coronary heart disease and 0.54 (SD, 0.12) for CVD, followed by carotid intima-media thickness <25th percentile (DLR, 0.65 [SD, 0.04] and 0.75 [SD, 0.04], respectively). High-sensitivity C-reactive protein <2 mg/L and normal ankle-brachial index had DLRs >0.80. Among clinical features, absence of any family history of coronary heart disease was the strongest (DLRs, 0.76 [SD, 0.07] and 0.81 [SD, 0.06], respectively). Net reclassification improvement analyses yielded similar findings, with coronary artery calcium score of 0 resulting in the largest, most accurate downward risk reclassification. CONCLUSIONS Negative results of atherosclerosis-imaging tests, particularly coronary artery calcium score of 0, resulted in the greatest downward shift in estimated CVD risk. These results may help guide discussions on the identification of individuals less likely to receive net benefit from lifelong preventive pharmacotherapy.
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Affiliation(s)
- Michael J Blaha
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, MD (M.J.B., M.C.-A., J.W.M., Z.D., R.S.B., K.N.); Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (M.C.-A.); Departments of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (P.G.); Brigham and Women's Hospital, Boston, MA (R.B.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.B.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (C.T.S.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); University of Washington, Seattle (R.A.K.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (M.J.B., M.S.); Center for Healthcare Advancement and Outcomes, and Miami Cardiac and Vascular Institute, Baptist Heath South Florida, Miami (K.N.).
| | - Miguel Cainzos-Achirica
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, MD (M.J.B., M.C.-A., J.W.M., Z.D., R.S.B., K.N.); Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (M.C.-A.); Departments of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (P.G.); Brigham and Women's Hospital, Boston, MA (R.B.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.B.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (C.T.S.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); University of Washington, Seattle (R.A.K.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (M.J.B., M.S.); Center for Healthcare Advancement and Outcomes, and Miami Cardiac and Vascular Institute, Baptist Heath South Florida, Miami (K.N.)
| | - Philip Greenland
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, MD (M.J.B., M.C.-A., J.W.M., Z.D., R.S.B., K.N.); Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (M.C.-A.); Departments of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (P.G.); Brigham and Women's Hospital, Boston, MA (R.B.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.B.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (C.T.S.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); University of Washington, Seattle (R.A.K.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (M.J.B., M.S.); Center for Healthcare Advancement and Outcomes, and Miami Cardiac and Vascular Institute, Baptist Heath South Florida, Miami (K.N.)
| | - John W McEvoy
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, MD (M.J.B., M.C.-A., J.W.M., Z.D., R.S.B., K.N.); Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (M.C.-A.); Departments of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (P.G.); Brigham and Women's Hospital, Boston, MA (R.B.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.B.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (C.T.S.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); University of Washington, Seattle (R.A.K.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (M.J.B., M.S.); Center for Healthcare Advancement and Outcomes, and Miami Cardiac and Vascular Institute, Baptist Heath South Florida, Miami (K.N.)
| | - Ron Blankstein
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, MD (M.J.B., M.C.-A., J.W.M., Z.D., R.S.B., K.N.); Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (M.C.-A.); Departments of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (P.G.); Brigham and Women's Hospital, Boston, MA (R.B.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.B.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (C.T.S.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); University of Washington, Seattle (R.A.K.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (M.J.B., M.S.); Center for Healthcare Advancement and Outcomes, and Miami Cardiac and Vascular Institute, Baptist Heath South Florida, Miami (K.N.)
| | - Matthew J Budoff
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, MD (M.J.B., M.C.-A., J.W.M., Z.D., R.S.B., K.N.); Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (M.C.-A.); Departments of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (P.G.); Brigham and Women's Hospital, Boston, MA (R.B.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.B.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (C.T.S.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); University of Washington, Seattle (R.A.K.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (M.J.B., M.S.); Center for Healthcare Advancement and Outcomes, and Miami Cardiac and Vascular Institute, Baptist Heath South Florida, Miami (K.N.)
| | - Zeina Dardari
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, MD (M.J.B., M.C.-A., J.W.M., Z.D., R.S.B., K.N.); Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (M.C.-A.); Departments of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (P.G.); Brigham and Women's Hospital, Boston, MA (R.B.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.B.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (C.T.S.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); University of Washington, Seattle (R.A.K.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (M.J.B., M.S.); Center for Healthcare Advancement and Outcomes, and Miami Cardiac and Vascular Institute, Baptist Heath South Florida, Miami (K.N.)
| | - Christopher T Sibley
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, MD (M.J.B., M.C.-A., J.W.M., Z.D., R.S.B., K.N.); Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (M.C.-A.); Departments of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (P.G.); Brigham and Women's Hospital, Boston, MA (R.B.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.B.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (C.T.S.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); University of Washington, Seattle (R.A.K.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (M.J.B., M.S.); Center for Healthcare Advancement and Outcomes, and Miami Cardiac and Vascular Institute, Baptist Heath South Florida, Miami (K.N.)
| | - Gregory L Burke
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, MD (M.J.B., M.C.-A., J.W.M., Z.D., R.S.B., K.N.); Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (M.C.-A.); Departments of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (P.G.); Brigham and Women's Hospital, Boston, MA (R.B.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.B.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (C.T.S.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); University of Washington, Seattle (R.A.K.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (M.J.B., M.S.); Center for Healthcare Advancement and Outcomes, and Miami Cardiac and Vascular Institute, Baptist Heath South Florida, Miami (K.N.)
| | - Richard A Kronmal
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, MD (M.J.B., M.C.-A., J.W.M., Z.D., R.S.B., K.N.); Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (M.C.-A.); Departments of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (P.G.); Brigham and Women's Hospital, Boston, MA (R.B.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.B.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (C.T.S.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); University of Washington, Seattle (R.A.K.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (M.J.B., M.S.); Center for Healthcare Advancement and Outcomes, and Miami Cardiac and Vascular Institute, Baptist Heath South Florida, Miami (K.N.)
| | - Moyses Szklo
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, MD (M.J.B., M.C.-A., J.W.M., Z.D., R.S.B., K.N.); Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (M.C.-A.); Departments of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (P.G.); Brigham and Women's Hospital, Boston, MA (R.B.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.B.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (C.T.S.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); University of Washington, Seattle (R.A.K.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (M.J.B., M.S.); Center for Healthcare Advancement and Outcomes, and Miami Cardiac and Vascular Institute, Baptist Heath South Florida, Miami (K.N.)
| | - Roger S Blumenthal
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, MD (M.J.B., M.C.-A., J.W.M., Z.D., R.S.B., K.N.); Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (M.C.-A.); Departments of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (P.G.); Brigham and Women's Hospital, Boston, MA (R.B.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.B.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (C.T.S.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); University of Washington, Seattle (R.A.K.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (M.J.B., M.S.); Center for Healthcare Advancement and Outcomes, and Miami Cardiac and Vascular Institute, Baptist Heath South Florida, Miami (K.N.)
| | - Khurram Nasir
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, MD (M.J.B., M.C.-A., J.W.M., Z.D., R.S.B., K.N.); Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (M.C.-A.); Departments of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (P.G.); Brigham and Women's Hospital, Boston, MA (R.B.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.B.); Knight Cardiovascular Institute, Oregon Health and Science University, Portland (C.T.S.); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.); University of Washington, Seattle (R.A.K.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (M.J.B., M.S.); Center for Healthcare Advancement and Outcomes, and Miami Cardiac and Vascular Institute, Baptist Heath South Florida, Miami (K.N.)
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