Abstract
Objective:This study evaluated the associations between the natriuretic peptide activity and the neurohormonal response in non-obese and obese outpatients with and without heart failure (HF).Background:Obesity-related HF may be a distinct subtype of HF. Obesity is associated with lower plasma concentrations of natriuretic peptides. The associations between obesity and neurohormonal activation estimated by mid-regional pro-adrenomedullin (MR-proADM) and copeptin in patients with HF is not elucidated.Methods:This prospective cohort-study included 392 outpatients ≥60years, plus ≥1 risk-factor(-s) for HF (hypertension, ischemic heart disease, atrial fibrillation, diabetes, chronic kidney disease), and without known HF. Patients were categorized ‘non-obese’ BMI = 18.5–29.9 kg/m2 (n = 273) and ‘obese’ BMI ≥ 30 kg/m2 (n = 119). The diagnosis of HF required signs, symptoms, and abnormal echocardiography. NT-proBNP, MR-proANP, MR-proADM, and copeptin were analyzed.Results:Obese patients were younger, had a higher prevalence of diabetes and chronic kidney disease, but a lower prevalence of atrial fibrillation. A total of 39 (14.3%) non-obese and 26 (21.8%) obese patients were diagnosed with HF. In obese patients, HF was not associated with higher plasma concentrations of NT-proBNP (Estimate: 0.063; 95%CI: –0.037–1.300; P = 0.064), MR-proANP (Estimate: 0.207; 95%CI: –0.101–0.515; P = 0.187), MR-proADM (Estimate: 0.112; 95%CI: –0.047–0.271; P = 0.168), or copeptin (Estimate: 0.093; 95%CI: –0.333–0.518; P = 0.669). Additionally, obese patients with HF had lower plasma concentrations of NT-proBNP (Estimate: –0.998; 95%CI: –1.778–0.218; P = 0.012), and MR-proANP (Estimate: –0.488; 95%CI: –0.845–0.132; P = 0.007) compared to non-obese patients with HF, whereas plasma concentrations of MR-proADM (Estimate: 0.066; 95%CI: –0.119–0.250; P = 0.484) and copeptin (Estimate: 0.140; 95%CI: –0.354–0.633; P = 0.578) were comparable.Conclusions:Patients with obesity-related HF have natriuretic peptide deficiency and lack of increased plasma concentrations of MR-proADM and copeptin suggesting that patients with obesity-related HF have a blunted overall neurohormonal activity.
Highlights
The global epidemic of obesity is an increasing burden of risk for heart failure (HF) [1, 2]
Various hypotheses of the pathophysiological mechanisms for obesity-related HF have been proposed: volume overload and increased afterload leading to hypertrophy of the left ventricle (LV) [7], lipotoxicity caused by increased circulating free fatty acids [8], altered metabolism in the myocardium due to insulin resistance [9], and activation of the leptin-aldosterone-neprilysin axis leading to sodium retention, plasma volume expansion and ventricular remodelling [10]
Obesity-related HF was associated with natriuretic peptide deficiency and an overall impaired neurohormonal activation in elderly outpatients with risk factors for HF
Summary
The global epidemic of obesity is an increasing burden of risk for HF [1, 2]. Obesity is a well-established risk factor for HF, independent of obesity-related conditions like hypertension, type 2 diabetes, and ischemic heart disease [3]. Considering that blockade or modulation of the neurohormonal activation is a cornerstone in the recommended treatment of patients with HFrEF [18] and is under evaluation in patients with HFpEF, obesity-related HF may be a subtype of HF, that due to natriuretic peptide deficiency, would benefit from a diverse management e.g. early treatment with sacubitril-valsartan. It is unknown whether obesity-related HF is associated with lower plasma concentrations of novel cardiac biomarkers like mid-regional pro-adrenomedullin (MR-proADM) and copeptin reflecting neurohormonal activation
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