title: Levels of N-terminal pro brain natriuretic peptide are enhanced in people with the uncomplicated metabolic syndrome: a case-cohort analysis of the population-based Casale Monferrato study.
abstract: BACKGROUND
  Both metabolic syndrome (MetS) and N-amino terminal fragment of the prohormone B-type natriuretic peptide (NT-proBNP) confer increased risk of cardiovascular diseases (CVD). We assessed if NT-proBNP levels were greater in people with uncomplicated MetS, who had neither CVD/chronic kidney disease (CKD) nor diabetes, as compared with subjects who met none of the defining criteria of the MetS.
  
  
  METHODS
  A case-cohort study from the non-diabetic population-based Casale Monferrato study was performed, after exclusion of all subjects with established CVD, CKD [estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m(2)], and CRP values ≥3 mg/L. Cases (n = 161) with MetS were compared with all subjects within the cohort (n = 124) who were completely free of any component of the MetS. Serum NT-proBNP was centrally measured by immunoenzymatic assay.
  
  
  RESULTS
  NT-proBNP levels were significantly higher in cases than in control subjects [35.4 (15.5-98.2) vs 24.4 (11.7-49.6) pg/mL, p = 0.014]. In logistic regression analysis, compared with NT-proBNP values in the lower quartiles (≤49.64 pg/mL), higher values conferred odds ratio 4.17 (1.30-13.44) of having the MetS, independently of age, sex, microalbuminuria, CRP, eGFR, and central obesity. This association was evident even after the exclusion of hypertensive subjects. Further adjustment for log-HOMA and diastolic blood pressure did not modify the strength of the association, while central obesity was a negative confounder.
  
  
  CONCLUSIONS
  Compared with people without any component of the MetS, those with uncomplicated MetS, who had neither CVD/CKD nor diabetes, had increased NT-proBNP values, even if they were normotensive and although absolute values were still in the low range. The insulin resistance state did not mediate this association, while central obesity was a negative confounder.
authors.affiliation: Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Graziella
authors.initials: G
authors.lastname: Bruno
authors.forename: Federica
authors.initials: F
authors.lastname: Barutta
authors.forename: Andrea
authors.initials: A
authors.lastname: Landi
authors.forename: Silvia
authors.initials: S
authors.lastname: Pinach
authors.forename: Paola
authors.initials: P
authors.lastname: Caropreso
authors.forename: Giulio
authors.initials: G
authors.lastname: Mengozzi
authors.forename: Stefano
authors.initials: S
authors.lastname: Baldassarre
authors.forename: Salvatore
authors.initials: S
authors.lastname: Fragapani
authors.forename: Stefania
authors.initials: S
authors.lastname: Civera
authors.forename: Paolo
authors.initials: P
authors.lastname: Cavallo Perin
authors.forename: Gabriella
authors.initials: G
authors.lastname: Gruden
mesh_terms: D000368:Aged; D015992:Body Mass Index; D016022:Case-Control Studies; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D050171:Dyslipidemias / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology; D007333:Insulin Resistance; D007558:Italy / Q000453:epidemiology; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood* / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D056128:Obesity, Abdominal / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D050177:Overweight / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D010446:Peptide Fragments / Q000097:blood*; D011236:Prediabetic State / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D012720:Severity of Illness Index; D015854:Up-Regulation; D055105:Waist Circumference
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: cardiovascular risk; hypertension; metabolic syndrome; natriuretic peptides; obesity; population-based study; survey