N-terminal pro B-Type natriuretic peptide is inversely correlated with low density lipoprotein cholesterol in the very elderly

https://doi.org/10.1016/j.numecd.2018.02.013Get rights and content

Highlights

  • Natriuretic peptides correlate with lipid parameters.

  • Higher NT-proBNP independently correlates with lower LDL cholesterol in very elderly.

  • The inverse correlation between NT-proBNP and LDL cholesterol is continuous.

  • Natriuretic peptides might play a role in LDL cholesterol metabolism.

Abstract

Background and aims

Laboratory studies on human adipose tissue and differentiated adipocytes indicate that natriuretic peptides (NPs) affect lipid metabolism and plasma cholesterol. Few previous clinical studies in non-elderly populations found associations between NPs in the physiological range and cholesterol. Aim: evaluate the association between NT-proBNP and lipid profile in very elderly hospitalized patients characterized by a wide range of NT-proBNP levels.

Methods and results

Cross-sectional study on 288 very elderly patients hospitalized for medical conditions, in which increased NT-proBNP levels are very common. NT-proBNP, total cholesterol (TC), HDL cholesterol (HDLc) and triglycerides were collected just few days before discharge. Patients taking lipid-lowering drugs and patients with an admission diagnosis of acute heart failure were excluded. Calculated LDL-cholesterol (LDLc) was used for the analyses. Mean age: 87.7 ± 6.2 years; female prevalence (57.3%). Median NT-proBNP: 2949 (1005–7335) pg/ml; mean TC: 145.1 ± 40.3 mg/dl; mean HDLc: 38.4 ± 18.6 mg/dl; median triglycerides: 100 (75–129) mg/dl; mean LDLc: 84.0 ± 29.5 mg/dl. We found negative correlations between NT-proBNP and both TC and LDLc (Rho = −0.157; p = 0.008 and Rho = −0.166; p = 0.005, respectively), while no correlations emerged between NT-proBNP and HDLc (Rho = −0.065; p = 0.275) or triglycerides (Rho = −0.009; p = 0.874). These associations were confirmed considering NT-proBNP tertiles. The inverse association between NT-proBNP and LDLc was maintained even after adjusting for confounding factors.

Conclusion

Our real-life clinical study supports the hypothesis that NPs play a role on cholesterol metabolism, given the association found between LDLc and NT-proBNP even in very elderly patients where NT-proBNP values are often in the pathological range.

Introduction

Cardiac natriuretic peptides (NPs) play a relevant role not only in blood pressure (BP) regulation, blood volume and sodium balances, but also in glucose and lipid metabolisms in both adipose and muscle tissues [1]. Scientific evidence suggests that higher NPs levels are associated with less obesity and metabolic syndrome (MetS) and a decreased risk of incident type 2 diabetes (DM2) [2]. Cardiac NPs system includes atrial NP (ANP) and B-type NP (BNP). ANP is likely to have a more physiological action, by influencing and controlling normal cardio–renal activities, while BNP is released mainly in response to muscular wall stretch, resulting from increased intravascular volume and/or cardiac transmural pressure, in conditions of cardiac stress, such as heart failure (HF) [3]. In common clinical practice, BNP and N-terminal proBNP (NT-proBNP) tests are recommended by guidelines for diagnosis, prognosis and guided therapy of HF, and also for risk stratification in patients with acute coronary syndromes [4]. Elderly patients have often raised NT-proBNP levels, due to the high prevalence of heart diseases [5]. Previous studies have evaluated the associations between plasma NPs levels, lipid profile and prevalence of dyslipidemia. However, most of these studies did not involve elderly subjects [6], [7]. To date, there is still conflicting evidence on the relationship between lipid profile and pathological levels of NPs. In a large cardiovascular (CV) disease-free cohort, the relationship was lost for higher NT-proBNP values [8]. Hypothesizing that NPs might affect lipid metabolism not only at physiological range, but also at pathological levels, we investigated the associations between plasma NT-proBNP levels and lipid profile in a “real life” clinical setting, by analyzing very elderly patients hospitalized for medical conditions.

Section snippets

Study population

Cross-sectional study on 288 very elderly consecutively admitted to an Internal Medicine and Geriatrics Department, from January 2015 to December 2016. We considered the following exclusion criteria: current therapy with lipid-lowering drugs or other drugs that could affect lipid profile (for example corticosteroids), clinical conditions that could affect lipid profile such as dysthyroidism, end-stage renal or liver diseases, advanced cancer and cachexia and an admission diagnosis of acute HF

Results

General characteristics of the studied population are summarized in Table 1. Mean age was 87.7 ± 6.2 years, with female prevalence (57.3%). Main admission diagnoses were chronic obstructive pulmonary disease (COPD) exacerbation (32.9%), pneumonia (23.6%), urinary tract infections or other infections (20.1%). Each patient could have more than one admission diagnosis. A significantly reduced renal function (eGFR < 60 ml/min/1.73 m2) was found in 43.1% of patients. Atrial fibrillation was found in

Discussion

In our “real-life” clinical study, NT-proBNP levels correlate with lipid parameters in a very elderly population. We studied very elderly patients because they often have high or very high NT-proBNP levels even without a formal HF diagnosis [5]. Higher NT-proBNP levels were associated with lower TC, LDLc and non-HDLc, even after adjusting for confounding factors. CV diseases (CVD) are leading causes of disability and death worldwide, especially in the elderly [13]. The association between

Conclusion

An association between NPs in the physiological range and lipid metabolism was found in previous studies. Circulating lipid levels can be reduced in very elderly, due to nutrition-related problems, frailty condition or end-stage organ diseases. In the present study, LDLc was inversely correlated with NT-proBNP, a biomarker of NPs secretion by the heart. This association was continuous even for higher values of NT-proBNP and independent of multiple possible confounding factors. Further basic

Funding sources

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflicts of interest statement

All authors declare they have no conflicts of interest.

References (30)

  • O.A. Sanchez et al.

    The associations between metabolic variables and NT-proBNP are blunted at pathological ranges: the Multi-Ethnic Study of Atherosclerosis

    Metabolism

    (2014)
  • K. Rockwood et al.

    A frailty index based on common laboratory tests in comparison with a clinical frailty index for older adults in long-term care facilities

    J Am Med Dir Assoc

    (2015)
  • I.J. Neeland et al.

    Higher natriuretic peptide levels associate with a favorable adipose tissue distribution profile

    J Am Coll Cardiol

    (2013)
  • R. Sarzani et al.

    Cardiac natriuretic peptides, hypertension and cardiovascular risk

    High Blood Press Cardiovasc Prev

    (2017)
  • S.K. Musani et al.

    Aldosterone, C-reactive protein, and plasma B-type natriuretic peptide are associated with the development of metabolic syndrome and longitudinal changes in metabolic syndrome components: findings from the Jackson heart study

    Diabetes Care

    (2013)
  • O. Nakagawa et al.

    Rapid transcriptional activation and early mRNA turnover of brain natriuretic peptide in cardiocyte hypertrophy. Evidence for brain natriuretic peptide as an “emergency” cardiac hormone against ventricular overload

    J Clin Invest

    (1995)
  • P. Ponikowski et al.

    2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)developed with the special contribution of the Heart Failure Association (HFA) of the ESC

    Eur Heart J

    (2016)
  • R. Sarzani et al.

    NT-proBNP and its correlation with in-hospital mortality in the very elderly without an admission diagnosis of heart failure

    PLoS One

    (2016)
  • M.H. Olsen et al.

    N-terminal pro brain natriuretic peptide is inversely related to metabolic cardiovascular risk factors and the metabolic syndrome

    Hypertension

    (2005)
  • A. Tanaka et al.

    N-terminal pro-brain natriuretic peptide and associated factors in the general working population: a baseline survey of the Uranosaki cohort study

    Sci Rep

    (2017)
  • A.S. Levey et al.

    A new equation to estimate glomerular filtration rate

    Ann Intern Med

    (2009)
  • S. Borson et al.

    The Mini-Cog as a screen for dementia: validation in a population-based sample

    J Am Geriatr Soc

    (2003)
  • J.N. Morris et al.

    Scaling ADLs within the MDS

    J Gerontol A Biol Sci Med Sci.

    (1999)
  • R. Rozzini et al.

    Geriatric Index of Comorbidity: validation and comparison with other measures of comorbidity

    Age Ageing

    (2002)
  • J.L. Fleg et al.

    Cardiovascular drug therapy in the elderly: benefits and challenges

    Nat Rev Cardiol

    (2011)
  • View full text