Obesity and natriuretic peptides, BNP and NT-proBNP: mechanisms and diagnostic implications for heart failure
Open accessAbstract
Many advances have been made in the diagnosis and management of heart failure (HF) in recent years. Cardiac biomarkers are an essential tool for clinicians: point of care B-type natriuretic peptide (BNP) and its N-terminal counterpart (NT-proBNP) levels help distinguish cardiac from non-cardiac causes of dyspnea and are also useful in the prognosis and monitoring of the efficacy of therapy. One of the major limitations of HF biomarkers is in obese patients where the relationship between BNP and NT-proBNP levels and myocardial stiffness is complex. Recent data suggest an inverse relationship between BNP and NT-proBNP levels and body mass index. Given the ever-increasing prevalence of obesity world-wide, it is important to understand the benefits and limitations of HF biomarkers in this population. This review will explore the biology, physiology, and pathophysiology of these peptides and the cardiac endocrine paradox in HF. We also examine the clinical evidence, mechanisms, and plausible biological explanations for the discord between BNP levels and HF in obese patients.
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Elevated natriuretic peptide concentrations support the diagnosis of heart failure and may guide further cardiac investigation.
“Still, elevated concentrations support the diagnosis of HF and may guide further cardiac investigation.488”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [488]
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References 119 · Cited by 357
- Authors
- Madamanchi, C., Alhosaini, H., Sumida, A., & Runge, M. S.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- East Carolina University (US)
- Corresponding author
- Runge, Marschall S.
- Venue
- International Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2014-10
- Volume
- 176
- Issue
- 3
- Pages
- 611-617
- ISSN
- 0167-5273 (ISSN-L)
- PMC
- PMC4201035
- OpenAlex
- W2070247508
- Cited by
- 357
- References
- 119
- Citations by year
- 2026: 34 · 2025: 47 · 2024: 44 · 2023: 41 · 2022: 29 · 2021: 35 · 2020: 33 · 2019: 17 · 2018: 28 · 2017: 20 · 2016: 21 · 2015: 8
- FWCI
- 2.63
- Type
- journal article
- Language
- en
- Update notices
- erratum (2026-06-15)
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- International Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Funders
- National Institutes of Health (UL1TR000083, UL1TR001111)
- National Heart, Lung, and Blood Institute (R01HL111664, HL111664)
- National Center for Advancing Translational Sciences (TR000083)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Fibrosis and Remodeling
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- obesity, heart failure, brain natriuretic peptide, NT-proBNP, cardiac biomarkers, body mass index, myocardial stiffness, dyspnea, prognosis
- MeSH terms
- Heart Failure, Humans, Obesity, Peptide Fragments, Predictive Value of Tests, Prognosis, Biomarkers, Body Mass Index, Natriuretic Peptide, Brain
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