title: BNP and obesity in acute decompensated heart failure with preserved vs. reduced ejection fraction: The Atherosclerosis Risk in Communities Surveillance Study.
abstract: BACKGROUND
  Levels of B-type natriuretic peptide (BNP), a prognostic marker in patients with heart failure (HF), are lower among HF patients with obesity or preserved Left Ventricular Ejection Fraction (LVEF). We examined the distribution and prognostic value of BNP across BMI categories in acute decompensated heart failure (ADHF) patients with preserved vs. reduced LVEF.
  
  
  METHODS
  We analyzed data from the Atherosclerosis Risk in Communities (ARIC) HF surveillance study which sampled and adjudicated ADHF hospitalizations in patients aged ≥55years from 4 US communities (2005-2009). We examined 5 BMI categories: underweight (<18.5kg/m2), normal weight (18.5-<25), overweight (25-<30), obese (30-<40) and morbidly obese (≥40) in HF with preserved LVEF (HFpEF) and reduced LVEF (HFrEF). The outcome was 1-year mortality from admission. We used ANCOVA to model log BNP and logistic regression for 1-year mortality, both adjusted for demographics and clinical characteristics.
  
  
  RESULTS
  The cohort included 9820 weighted ADHF hospitalizations (58% HFrEF; 42% HFpEF). BNP levels were lower in HFpEF compared to HFrEF (p<0.001) and decreased as BMI increased within the LVEF groups (p<0.001). After adjustment for covariates, log10 BNP independently predicted 1-year mortality (adjusted OR 1.62 (95% CI 1.17-2.24)) with no significant interaction by BMI or LVEF groups.
  
  
  CONCLUSIONS
  BNP levels correlated inversely with BMI, and were higher in HFrEF compared to HFpEF. Obese patients with HFpEF and ADHF had a significant proportion with BNP levels below clinically accepted thresholds. Nevertheless, BNP was a predictor of mortality in ADHF across groups of BMI in HFpEF and HFrEF.
authors.affiliation: Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States.
authors.forename: Umair
authors.initials: U
authors.lastname: Khalid
authors.affiliation: Department of Biostatistics, University of North Carolina, Chapel Hill, NC, United States.
authors.forename: Lisa Miller
authors.initials: LM
authors.lastname: Wruck
authors.affiliation: Department of Biostatistics, University of North Carolina, Chapel Hill, NC, United States.
authors.forename: Pedro Miguel
authors.initials: PM
authors.lastname: Quibrera
authors.affiliation: Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Section of Cardiology, Michael E. DeBakey VA Medical Center, Houston, TX, United States.
authors.forename: Biykem
authors.initials: B
authors.lastname: Bozkurt
authors.affiliation: Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Section of Cardiology, Michael E. DeBakey VA Medical Center, Houston, TX, United States.
authors.forename: Vijay
authors.initials: V
authors.lastname: Nambi
authors.affiliation: Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Section of Cardiology, Michael E. DeBakey VA Medical Center, Houston, TX, United States.
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
authors.affiliation: Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Section of Cardiology, Michael E. DeBakey VA Medical Center, Houston, TX, United States.
authors.forename: Hani
authors.initials: H
authors.lastname: Jneid
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, MD, United States.
authors.forename: Sunil
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Department of Medicine, University of North Carolina, Chapel Hill, NC, United States.
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Chang
authors.affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill, NC, United States.
authors.forename: Laura
authors.initials: L
authors.lastname: Loehr
authors.affiliation: Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States.
authors.forename: Sukhdeep Singh
authors.initials: SS
authors.lastname: Basra
authors.affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill, NC, United States.
authors.forename: Wayne
authors.initials: W
authors.lastname: Rosamond
authors.affiliation: Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States.
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.affiliation: Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Section of Cardiology, Michael E. DeBakey VA Medical Center, Houston, TX, United States. Electronic address: adeswal@bcm.edu.
authors.forename: Anita
authors.initials: A
authors.lastname: Deswal
mesh_terms: D000208:Acute Disease; D000368:Aged; D050197:Atherosclerosis / Q000097:blood* / Q000150:complications / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009767:Obesity, Morbid / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
keywords: B-type natriuretic peptide; Body mass index; Heart failure; Obesity