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Yu SR, Zhang CY, Xiong WJ, Chen JT, Song JX, Chen H. An Hypothesis: Disproportion Between Cardiac Troponin and B-Type Natriuretic Peptide Levels—A High Risk and Poor Prognostic Biomarker in Patients With Fulminant Myocarditis? Heart Lung Circ 2021; 30:837-842. [DOI: 10.1016/j.hlc.2020.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/28/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022]
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Terzic D, Zois NE, Hunter I, Christoffersen C, Plomgaard P, Olsen LH, Ringholm S, Pilegaard H, Goetze JP. Effect of insulin on natriuretic peptide gene expression in porcine heart. Peptides 2020; 131:170370. [PMID: 32663503 DOI: 10.1016/j.peptides.2020.170370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 11/16/2022]
Abstract
Gut hormones affect cardiac function and contractility. In this study, we examined whether insulin affects the cardiac atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) gene expression and release of proANP-derived peptides in pigs. Anaesthetized pigs were included in an experimental study comparing the effect of hyperinsulinemia in 15 pigs submitted to two different protocols versus 11 control pigs receiving saline infusion. Phosphorylation of Akt on Thr308 was determined by western blotting with a pAkt-Thr308 antibody. The mRNA contents of ANP and BNP were determined with real-time PCR; plasma and cardiac tissue proANP was measured with an immunoluminometric assay targeted against the mid-region of the propeptide and a processing-independent assay. Insulin stimulation increased phosphorylation of Akt Thr308 in both left atrium and left ventricle of porcine hearts (p < 0.005). No change was observed in ANP and BNP mRNA contents in the right or left atrium. BNP mRNA contents in the left ventricle, however, decreased 3-fold (p = 0.02) compared to control animals, whereas the BNP mRNA content in the right ventricle as well as ANP mRNA content in the right and left ventricle did not change following hyperinsulinemia. Moreover, the peptide contents did not change in the four cardiac chambers. Finally, proANP concentrations in plasma did not change during the insulin infusion compared to the control animals. These results suggest that insulin does not have direct effect on atrial natriuretic peptide expression but may have a role in the left ventricle.
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Affiliation(s)
- Dijana Terzic
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Nora E Zois
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Ingrid Hunter
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Christina Christoffersen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Plomgaard
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Lisbeth Høier Olsen
- Department of Veterinary and Animal Sciences, University of Copenhagen, Denmark
| | - Stine Ringholm
- Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | | | - Jens P Goetze
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Spannella F, Giulietti F, Bordicchia M, Burnett JC, Sarzani R. Association Between Cardiac Natriuretic Peptides and Lipid Profile: a Systematic Review and Meta-Analysis. Sci Rep 2019; 9:19178. [PMID: 31844088 PMCID: PMC6915780 DOI: 10.1038/s41598-019-55680-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/20/2019] [Indexed: 02/08/2023] Open
Abstract
Cardiac natriuretic peptides (NPs) play a fundamental role in maintaining cardiovascular (CV) and renal homeostasis. Moreover, they also affect glucose and lipid metabolism. We performed a systematic review and meta-analysis of studies investigating the association of NPs with serum lipid profile. A PubMed and Scopus search (2005–2018) revealed 48 studies reporting the association between NPs and components of lipid profile [total cholesterol (TC), low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc) and triglycerides (TG)]. Despite high inconsistency across studies, NPs levels were inversely associated with TC [k = 32; pooled r = −0.09; I2 = 90.26%], LDLc [k = 31; pooled r = −0.09; I2 = 82.38%] and TG [k = 46; pooled r = −0.11; I2 = 94.14%], while they were directly associated with HDLc [k = 41; pooled r = 0.06; I2 = 87.94%]. The relationship with LDLc, HDLc and TG lost significance if only studies on special populations (works including subjects with relevant acute or chronic conditions that could have significantly affected the circulating levels of NPs or lipid profile) or low-quality studies were taken into account. The present study highlights an association between higher NP levels and a favorable lipid profile. This confirms and extends our understanding of the metabolic properties of cardiac NPs and their potential in CV prevention.
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Affiliation(s)
- Francesco Spannella
- Internal Medicine and Geriatrics, IRCCS INRCA, Via della Montagnola 81, Ancona, Italy.,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Via Tronto 10/a, Ancona, Italy
| | - Federico Giulietti
- Internal Medicine and Geriatrics, IRCCS INRCA, Via della Montagnola 81, Ancona, Italy.,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Via Tronto 10/a, Ancona, Italy
| | - Marica Bordicchia
- Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Via Tronto 10/a, Ancona, Italy
| | - John C Burnett
- Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Riccardo Sarzani
- Internal Medicine and Geriatrics, IRCCS INRCA, Via della Montagnola 81, Ancona, Italy. .,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Via Tronto 10/a, Ancona, Italy.
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4
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Zhang H, Thoonen R, Yao V, Buys ES, Popovich J, Su YR, Wang TJ, Scherrer-Crosbie M. Regulation of B-type natriuretic peptide synthesis by insulin in obesity in male mice. Exp Physiol 2015; 101:113-23. [PMID: 26446173 DOI: 10.1113/ep085091] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 09/25/2015] [Indexed: 01/07/2023]
Abstract
Human studies suggest that insulin resistance and obesity are associated with a decrease in B-type natriuretic peptide (BNP) plasma concentrations. The objective of the study was to gain insights into the mechanisms involved in the association between insulin resistance and decreased BNP plasma concentrations. Mice fed a high-fat, high-fructose (HFHF) diet for 4 weeks developed mild obesity and systemic insulin resistance. Elevated plasma concentrations of insulin, glucose and triglycerides were noted. The HFHF diet was also associated with myocardial insulin resistance, characterized by an impaired response of the phosphoinositide 3-kinase-AKT (PI3K-AKT) pathway to insulin in the left ventricle. Myocardial BNP expression and protein were decreased in HFHF-fed mice compared with control animals. Exposure of cardiomyocytes to 100 nm insulin activated PI3K-AKT signalling (15 min) and induced a 1.9 ± 0.3-fold increase in BNP gene expression (6 h). Prolonged exposure of cardiomyocytes to a high insulin concentration (100 nm) for 48 h induced insulin resistance, characterized by an impaired response of the PI3K-AKT signalling pathway and a decreased response of the BNP gene expression to insulin. The decreased response in BNP gene expression was reproduced by treating cardiomyocytes for 7 h with a PI3-kinase inhibitor (wortmannin). In conclusion, HFHF diet in vivo, prolonged exposure to an elevated concentration of insulin or inhibition of the PI3K-AKT pathway in vitro all decrease BNP mRNA levels; this decrease may in turn contribute to the decreased BNP peptide concentrations in plasma observed in insulin-resistant individuals.
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Affiliation(s)
- Haihua Zhang
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Robrecht Thoonen
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Vincent Yao
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Emmanuel S Buys
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John Popovich
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yan Ru Su
- Division of Cardiovascular Medicine, Vanderbilt University, Nashville, TN, USA
| | - Thomas J Wang
- Division of Cardiovascular Medicine, Vanderbilt University, Nashville, TN, USA
| | - Marielle Scherrer-Crosbie
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Cardiac Ultrasound Laboratory, Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Meroufel DN, Ouhaïbi-Djellouli H, Mediene-Benchekor S, Hermant X, Grenier-Boley B, Lardjam-Hetraf SA, Boulenouar H, Hamani-Medjaoui I, Saïdi-Mehtar N, Amouyel P, Houti L, Goumidi L, Meirhaeghe A. Examination of the brain natriuretic peptide rs198389 single-nucleotide polymorphism on type 2 diabetes mellitus and related phenotypes in an Algerian population. Gene 2015; 567:159-63. [PMID: 25934190 DOI: 10.1016/j.gene.2015.04.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 04/14/2015] [Accepted: 04/27/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND In European populations, the NPPB rs198389 single nucleotide polymorphism (SNP) is associated with a reduced risk of type 2 diabetes mellitus (T2DM). We investigated the putative associations between NPPB rs198389, the T2DM risk and quantitative metabolic traits in an Algerian population. METHODS The association analysis was performed as a T2DM case-control study (with 78 cases and 645 controls) nested into the ISOR population-based study. RESULTS The NPPB rs198389 SNP was not associated with T2DM (odds ratio (OR) [95% confidence interval (CI)]=0.73 [0.51-1.04], p=0.08). However, the C allele was associated with lower fasting plasma insulin levels (p=0.05) and a lower homeostatic model assessment insulin resistance index (p=0.05) in non-diabetic individuals. CONCLUSION The NPPB rs198389 SNP might modulate fasting insulin levels in an Algerian population.
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Affiliation(s)
- Djabaria Naïma Meroufel
- Laboratoire de Génétique Moléculaire et Cellulaire, Université des Sciences et de Technologie d'Oran Mohamed Boudiaf, BP 1505, El M'Naouer, 31000 Oran, Algeria.
| | - Hadjira Ouhaïbi-Djellouli
- Laboratoire de Génétique Moléculaire et Cellulaire, Université des Sciences et de Technologie d'Oran Mohamed Boudiaf, BP 1505, El M'Naouer, 31000 Oran, Algeria; Département de Biotechnologie, Faculté des Sciences de la Nature et de la Vie, Université d'Oran, BP 1524, El M'Naouer, 31000 Oran, Algeria.
| | - Sounnia Mediene-Benchekor
- Laboratoire de Génétique Moléculaire et Cellulaire, Université des Sciences et de Technologie d'Oran Mohamed Boudiaf, BP 1505, El M'Naouer, 31000 Oran, Algeria; Département de Biotechnologie, Faculté des Sciences de la Nature et de la Vie, Université d'Oran, BP 1524, El M'Naouer, 31000 Oran, Algeria.
| | - Xavier Hermant
- INSERM, U1167, Institut Pasteur de Lille, Université de Lille, 1 rue du Pr. Calmette, BP 245, F-59019 Lille cedex, France.
| | - Benjamin Grenier-Boley
- INSERM, U1167, Institut Pasteur de Lille, Université de Lille, 1 rue du Pr. Calmette, BP 245, F-59019 Lille cedex, France.
| | - Sarah Aïcha Lardjam-Hetraf
- Laboratoire de Génétique Moléculaire et Cellulaire, Université des Sciences et de Technologie d'Oran Mohamed Boudiaf, BP 1505, El M'Naouer, 31000 Oran, Algeria.
| | - Houssam Boulenouar
- Laboratoire de Génétique Moléculaire et Cellulaire, Université des Sciences et de Technologie d'Oran Mohamed Boudiaf, BP 1505, El M'Naouer, 31000 Oran, Algeria.
| | - Imane Hamani-Medjaoui
- Laboratoire de Génétique Moléculaire et Cellulaire, Université des Sciences et de Technologie d'Oran Mohamed Boudiaf, BP 1505, El M'Naouer, 31000 Oran, Algeria; Caisse Nationale des Assurances Sociales des travailleurs salariés, Clinique Spécialisée en Orthopédie et Rééducation des Victimes des Accidents de Travail, Hai Bouamama (El Hassi) Oran, Algeria.
| | - Nadhira Saïdi-Mehtar
- Laboratoire de Génétique Moléculaire et Cellulaire, Université des Sciences et de Technologie d'Oran Mohamed Boudiaf, BP 1505, El M'Naouer, 31000 Oran, Algeria.
| | - Philippe Amouyel
- INSERM, U1167, Institut Pasteur de Lille, Université de Lille, 1 rue du Pr. Calmette, BP 245, F-59019 Lille cedex, France.
| | - Leïla Houti
- Laboratoire de Génétique Moléculaire et Cellulaire, Université des Sciences et de Technologie d'Oran Mohamed Boudiaf, BP 1505, El M'Naouer, 31000 Oran, Algeria; Faculté de Médecine, Université Djillali Liabes de Sidi Bel Abbes, BP 89, 22000 Sidi-Bel-Abbès, Algeria; Laboratoire des Systèmes d'Information en Santé, Université d'Oran, BP 1524, El M'Naouer, 31000 Oran, Algeria.
| | - Louisa Goumidi
- INSERM, U1167, Institut Pasteur de Lille, Université de Lille, 1 rue du Pr. Calmette, BP 245, F-59019 Lille cedex, France.
| | - Aline Meirhaeghe
- INSERM, U1167, Institut Pasteur de Lille, Université de Lille, 1 rue du Pr. Calmette, BP 245, F-59019 Lille cedex, France.
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Asferg CL, Nielsen SJ, Andersen UB, Linneberg A, Møller DV, Hedley PL, Christiansen M, Gøtze JP, Jeppesen JL. Metabolic rather than body composition measurements are associated with lower serum natriuretic peptide concentrations in normal weight and obese men. Am J Hypertens 2014; 27:620-7. [PMID: 24025723 DOI: 10.1093/ajh/hpt145] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Several studies have shown that obese persons have lower circulating natriuretic peptide (NP) concentrations. The cause of the relative NP deficiency seen in obese persons is poorly understood, although variation in body composition and metabolic abnormalities has been suggested to play a role. Thus, the aim of this study was to assess whether variation in circulating NP concentrations would be associated with differences in metabolic disturbances rather than with differences in body composition. METHODS In 27 normal weight men (body mass index (BMI) = 20.0-24.9kg/m(2)) and 103 obese men (BMI ≥ 30kg/m(2)), we determined body composition (total, android, and gynoid fat mass) by dual energy x-ray absorptiometry scanning, and we measured fasting serum concentrations of midregional proatrial NP (MR-proANP) and insulin, as well as fasting plasma glucose concentrations. RESULTS Mean weight ± SD was 74.9±6.7kg in the normal weight men and 106.1±10.8kg in obese men. Applying multiple regressions, adjusting for age and weight status (normal weight vs. obese), serum MR-proANP concentrations were significantly inversely associated with serum insulin concentrations (β = -0.39; P < 0.0001) and plasma glucose concentrations (β = -0.21; P = 0.02) but not with total (β = 0.00), android (β = -0.01), or gynoid (β = 0.03) fat mass percentage (P > 0.76). No significant interaction effects between metabolic measurements or body composition measurements and weight status on MR-proANP concentrations were found (P > 0.08). CONCLUSIONS In normal weight and obese men, lower circulating NP concentrations are associated with higher insulin and glucose concentrations and not with the proportion of total fat mass or the distribution of fat mass.
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Affiliation(s)
- Camilla L Asferg
- Department of Diagnostics, Copenhagen University Hospital Glostrup, Glostrup, Denmark
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Hsieh JC, Wang JH, Lee CJ, Chen YC, Liou HH, Hsu BG. Low serum long-acting natriuretic peptide level correlates with metabolic syndrome in hypertensive patients: a cross-sectional study. Arch Med Res 2013; 44:215-20. [PMID: 23506722 DOI: 10.1016/j.arcmed.2013.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 02/28/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS Long-acting natriuretic peptide (LANP) is one of the peptide hormones in atrial natriuretic peptide (ANP) prohormone. Its biological properties are blood pressure regulation, maintenance of plasma volume and anticancer effects. The aim of this study was to evaluate the relationship between metabolic syndrome (MetS) and fasting serum LANP concentration in hypertensive patients. METHODS Fasting blood samples were obtained from 224 patients with or without hypertension. MetS and its components were defined using diagnostic criteria from the International Diabetes Federation. RESULTS Eighty-eight hypertensive patients (59.5 %) had MetS. Hypertensive patients with MetS had higher body weight (p = 0.003), waist circumference (p = 0.003), body mass index (p = 0.002), triglyceride concentrations (p = 0.029), insulin levels (p = 0.001), HOMA-IR (p <0.003) and HOMA-β (p = 0.049) and lower HDL-C concentrations (p = 0.001), LANP levels (p = 0.012) than those without MetS. The univariable linear regression analysis showed that age (p = 0.038) and the BUN concentration (p = 0.022) were positively correlated with the serum LANP levels, whereas the insulin level (p = 0.001), HOMA-IR (p = 0.004), and HOMA-β (p = 0.001) were negatively correlated with the fasting serum LANP levels among the hypertensive patients. Multivariable forward stepwise linear regression analysis of the significant variables showed that the HOMA-β (β = -0.387, R(2) = 0.141, p <0.001) was an independent predictor of fasting serum LANP levels in hypertensive patients. CONCLUSIONS LANP level is significantly reduced in hypertensive patients affected by MetS and is negatively related to pancreatic beta cell function in hypertensive patients.
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Affiliation(s)
- Jen-Che Hsieh
- Division of Cardiology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
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Mizuno Y, Harada E, Katoh D, Kashiwagi Y, Morikawa Y, Nakagawa H, Yoshimura M, Saito Y, Yasue H. Cardiac production of B-type natriuretic peptide is inversely related to the plasma level of free fatty acids in obese individuals - possible involvement of the insulin resistance -. Endocr J 2013; 60:87-95. [PMID: 23006812 DOI: 10.1507/endocrj.ej12-0239] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
B-type natriuretic peptide (BNP) is produced by the heart and its plasma level is increased with the severity of left ventricular (LV) dysfunction/hypertrophy. The normal heart preferentially utilizes fatty acids as energy substrates. Plasma BNP levels are reported to be lower in obese individuals. We examined the relationship between BNP production and plasma free fatty acids (FFA), homeostasis model assessment of insulin resistance (HOMA-IR), and LV dysfunction/ hypertrophy. We examined the plasma BNP levels and FFA at the aortic root (AO) and coronary sinus (CS) as well as hemodynamic parameters in 62 patients (38 men and 24 women, 62.5±11.7 yrs) who underwent cardiac catheterization. Log BNP (AO) had a significant positive correlation with log BNP (CS-AO) (r=0.877, P<0.001). Log BNP(CS-AO) had a significant negative correlation with BMI (r=-0.558, P<0.001), waist circumference (WC) (r=-0.574, P<0.001), log FFA(AO) (r=-0.643, P<0.001), log triglyceride (r=-0.431, P<0.001), and log HOMA-IR (r=-0.463, P<0.001) and a significant positive correlation with left ventricular mass index (LVMI) (r=0.403, P=0.001). The multivariable regression analyses including log HOMA-IR, LVMI, and age as an independent variable revealed that HOMA-IR and LVMI were significant predictors of log BNP (CS-AO) or BNP production (P=0.001 and 0.004, respectively). We conclude that plasma BNP levels are determined primarily by cardiac production and that insulin resistance is a significant predictor of cardiac BNP production independent of LV hypertrophy in obese individuals.
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Affiliation(s)
- Yuji Mizuno
- Division of Cardiovascular Medicine, Kumamoto Aging Research Institute / Kumamoto Kinoh Hospital, Kumamoto 860-8518, Japan.
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Reinhard H, Garde E, Skimminge A, Åkeson P, Ramsøy TZ, Winther K, Parving HH, Rossing P, Jacobsen PK. Plasma NT-proBNP and white matter hyperintensities in type 2 diabetic patients. Cardiovasc Diabetol 2012; 11:119. [PMID: 23033840 PMCID: PMC3503686 DOI: 10.1186/1475-2840-11-119] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 09/20/2012] [Indexed: 11/14/2022] Open
Abstract
Abstract Elevated plasma N-terminal (NT)-proBNP from the heart as well as white matter hyperintensities (WMH) in the brain predict cardiovascular (CV) mortality in the general population. The cause of poor prognosis associated with elevated P-NT-proBNP is not known but WMH precede strokes in high risk populations. We assessed the association between P-NT-proBNP and WMH or brain atrophy measured with magnetic resonance imaging (MRI) in type 2 diabetic patients, and age-matched controls. Methods and results We measured P-NT-proBNP(ng/l) in 20 diabetic patients without prior stroke but with(n = 10) or without(n = 10) asymptomatic coronary artery disease(CAD) in order to include patients with a wide-ranging CV risk profile. All patients and 26 controls had a 3D MRI and brain volumes(ml) with WMH and brain parenchymal fraction(BPF), an indicator of brain atrophy, were determined. P-NT-proBNP was associated with WMH in linear regression analysis adjusted for CV risk factors(r = 0.94, p = 0.001) and with BPF in univariate analysis(r = 0.57, p = 0.009). Patients divided into groups of increased P-NT-proBNP levels were paralleled with increased WMH volumes(geometric mean[SD];(2.86[5.11] ml and 0.76[2.49] ml compared to patients with low P-NT-proBNP 0.20[2.28] ml, p = 0.003)) and also when adjusted for age, sex and presence of CAD(p = 0.017). The association was strengthened by CV risk factors and we did not find a common heart or brain specific driver of both P-NT-proBNP and WMH. Patients and particular patients with CAD had higher WMH, however no longer after adjustment for age and sex. Conclusion P-NT-proBNP was associated with WMH in type 2 diabetic patients, suggesting a linkage between heart and brain disease.
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