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Korean Circ J.  2010 Nov;40(11):558-564. 10.4070/kcj.2010.40.11.558.

Relationship Between Obesity and N-Terminal Brain Natriuretic Peptide Level as a Prognostic Value After Acute Myocardial Infarction

Affiliations
  • 1Department of Internal Medicine, Yeosu Chonnam Hospital, Yeosu, Korea.
  • 2Department of Internal Medicine, The Heart Center of Chonnam National University Hospital, Gwangju, Korea. myungho@chollian.net
  • 3Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu, Korea.
  • 4Department of Internal Medicine, Keimyung University College of Medicine, Daegu, Korea.
  • 5Department of Internal Medicine, Pusan National University Schoool of Medicine, Busan, Korea.
  • 6Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
  • 7Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea.
  • 8Department of Internal Medicine, Chonbuk National University College of Medicine, Jeonju, Korea.
  • 9Department of Internal Medicine, Jeonju Presbyterian Medical Center, Jeonju, Korea.
  • 10Department of Internal Medicine, Seoul National University College of Medicine, Seongnam, Korea.
  • 11Department of Internal Medicine, Chungbuk National College of Medicine, Cheongju, Korea.
  • 12Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea.
  • 13Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
  • 14Department of Internal Medicine, Kyunghee University College of Medicine, Seoul, Korea.
  • 15Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
  • 16Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
  • 17Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
  • 18Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.

Abstract

BACKGROUND AND OBJECTIVES
Recently, the prognostic value of N-terminal brain natriuretic peptide (NT-proBNP) in acute coronary syndrome has been demonstrated in many studies. However, NT-proBNP levels are influenced by various factors such as sex, age, renal function, heart failure severity, and obesity. NT-proBNP concentrations tend to decrease with higher body mass index (BMI). The aim of this study was to examine the influence of obesity on NT-proBNP as a predictive prognostic factor in acute myocardial infarction (AMI) patients.
SUBJECTS AND METHODS
Using data from the Korea Acute Myocardial Infarction Registry (January 2005 to September 2008), 2,736 AMI patients were included in this study. These patients were divided into men (n=1,972, 70%) and women (n=764, 30%), and were grouped according to their BMIs. Major adverse cardiac events (MACE) during 1 year clinical follow-up were evaluated.
RESULTS
NT-proBNP was significantly higher in lower BMI (p<0.001). Mean NT-proBNP levels of each obesity group were 2,393+/-4,022 pg/mL in the lean group (n=875), 1,506+/-3,074 pg/mL in the overweight group (n=724) and 1,100+/-1,137 pg/mL in the obese group (n=1,137) (p<0.01). NT-proBNP was an independent prognostic factor of AMI in obese patients by multivariative analysis of independent risk factors of MACE (p=0.01).
CONCLUSION
NT-proBNP is lower in obese AMI patients than in non-obese AMI patients, but NT-proBNP is still of independent prognostic value in obese AMI patients.

Keyword

Brain natriuretic peptide; Obesity; Myocardial infarction

MeSH Terms

Acute Coronary Syndrome
Body Mass Index
Brain
Female
Follow-Up Studies
Heart Failure
Humans
Korea
Male
Myocardial Infarction
Natriuretic Peptide, Brain
Obesity
Overweight
Peptide Fragments
Risk Factors
Natriuretic Peptide, Brain
Peptide Fragments

Figure

  • Fig. 1 Box-plot of NT-proBNP and Killip class. NT-proBNP was lower in the Killip class I group than in the Killip class II, III, IV groups (1,174±2,240 pg/mL vs. 3,353±5,329 pg/mL, p<0.001). NT-proBNP: N-terminal brain natriuretic peptide.

  • Fig. 2 Box-plot of NT-proBNP in patients with and without MACE. NT-proBNP was lower in patients without MACE (group I) than in patient with MACE (group II) (1,519±3,088 pg/mL vs. 2,548±4,469 pg/mL, p=0.001). NT-proBNP: N-terminal brain natriuretic peptide, MACE: major adverse cardiac events.

  • Fig. 3 Box-plot of NT-proBNP and three weight groups categorized by BMI. p=0.001 calculated by Kruskal-Wallis test. NT-proBNP: N-terminal brain natriuretic peptide, BMI: body mass index.


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