Abstract
Glucose is an important preferential substrate for energy metabolism during acute coronary syndrome (ACS) attack, although insulin resistance (IR) increases during ACS. Increasing evidence indicates that natriuretic peptides (NP) regulate glucose homeostasis. We investigated possible compensatory actions of NP in collaboration with other neurohumoral factors that facilitate glucose utilization during ACS. The study population consisted of 1072 consecutive cases with ischemic heart disease who underwent cardiac catheterization (ACS, n = 216; non-ACS, n = 856). Among ACS subjects, biochemical data after acute-phase treatment were available in 91 cases, defined as ACS-remission phase (ACS-rem). Path models based on covariance structure analyses were proposed to clarify the direct contribution of B-type NP (BNP) and noradrenaline to glucose and HOMA-IR levels while eliminating confounding biases. In non-ACS and ACS-rem subjects, although noradrenaline slightly increased glucose and/or HOMA-IR levels (P < 0.03), BNP did not significantly affect them. In contrast, in ACS subjects, high noradrenaline was a significant cause of increases in glucose and HOMA-IR levels (P < 0.001), whereas high BNP was a significant cause of decreases in both parameters (P < 0.005). These findings indicate that BNP and noradrenaline coordinately activate glucose metabolism during ACS, with noradrenaline increasing glucose levels, as an energy substrate, while BNP improves IR and promotes glucose utilization.
Highlights
Natriuretic peptides (NPs) are produced in the heart and classically act on the renal and cardiovascular systems[8]
The levels of glucose, insulin, HOMA-insulin resistance (IR), B-type NP (BNP) and noradrenaline were all decreased during the remission phase of acute coronary syndrome (ACS) compared to during ischemic attack (Supplementary Table S1)
Of the positive correlation between BNP and noradrenaline revealed that, in ACS subjects, high noradrenaline levels were a significant cause of increases in glucose levels (Path model A, β = 0.356, P < 0.001) and homeostasis model assessment of IR (HOMA-IR) (Path model C, β = 0.277, P < 0.001), whereas high BNP levels were a significant cause of decreases in glucose levels (Path model A, β = −0.168, P = 0.003) and HOMA-IR (Path model C, β = −0.230, P = 0.001)
Summary
Natriuretic peptides (NPs) are produced in the heart and classically act on the renal and cardiovascular systems[8]. Www.nature.com/scientificreports systemic glucose regulations in humans showed that B-type NP (BNP) administration reduces the plasma glucose concentration[17]. Another in vitro study showed that NP increases the glucose uptake during hypoxia in cardiomyocytes[18]. Using a covariance structure analysis together with conventional single and multiple regression analyses, this study was designed to evaluate the possible regulation of plasma glucose levels as well as the degree of IR by noradrenaline and BNP in patients with ACS compared to those with non-ACS
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