体重指数可改变急性冠脉综合征患者中NT-proBNP的主要不良心血管和脑血管事件风险。

Body mass index modifies the major adverse cardiovascular and cerebral events risk of NT-proBNP in patients with acute coronary syndrome.

作者信息

He Xiaoquan, Fang Xiaojing, Wang Jiali, Zhao Shumei, Ding Xiaosong, Chen Hui

机构信息

Department of Cardiology, Cardiovascular Centre, Beijing Friendship Hospital, Capital Medical University, No.95, Yongan Road, Xicheng District, Beijing, 100050, People's Republic of China.

Department of neurology, First Hospital of Tsinghua University, No.6 Jiuxianqiao 1st Street, Chaoyang District, Beijing, 100016, People's Republic of China.

出版信息

Diabetol Metab Syndr. 2025 Mar 18;17(1):88. doi: 10.1186/s13098-025-01668-x.

DOI:10.1186/s13098-025-01668-x

PMID:40102940

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11916518/

Abstract

BACKGROUND

Little is known about the relationship between body mass index (BMI) and the prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with acute coronary syndrome (ACS). This study aimed to investigate how BMI modifies the association between NT-proBNP levels and clinical outcomes in ACS patients.

METHODS

A total of 11,757 ACS patients from the Cardiovascular Centre Beijing Friendship Hospital were recruited. The association between NT-proBNP and major adverse cardiovascular and cerebral events (MACCEs) was assessed using multivariate Cox proportional hazards models. The multiplicative interaction between NT-proBNP and BMI was evaluated using the Wald χ test.

RESULTS

During the median follow-up time of 3.04 (IQR: 1.07‒5.02) years (33,232 person-years), 1996 MACCEs were documented. A significant multiplicative interaction was observed between natural logarithm (Ln)-NT-proBNP and BMI (p for multiplicative interaction = 0.013). The categorical thresholds of NT-porBNP for the risk of MACCEs were 1559, 155, and 419 pg/ml for normoweight, overweight, and obese patients, respectively. When NT-proBNP levels were near-normal or mildly elevated (≤ 300 pg/ml), overweight and obese patients exhibited a higher event probability than normoweight patients at a given NT-proBNP level. However, an opposite trend was observed at significantly elevated NT-proBNP levels (> 300 pg/ml), with normoweight patients showing a higher event probability. When BMI and NT-proBNP were considered jointly, normoweight patients with elevated NT-proBNP had a significantly higher risk of MACCEs than overweight patients without elevated NT-proBNP (hazard ratio: 2.28; 95% confidence interval: 1.83‒2.84; p < 0.001).

CONCLUSION

The prognostic value of NT-proBNP in ACS patients varies with BMI, with the extent of NT-proBNP elevation playing a role in this relationship.

摘要

背景

关于急性冠状动脉综合征（ACS）患者体重指数（BMI）与N末端B型利钠肽原（NT-proBNP）预后价值之间的关系，目前所知甚少。本研究旨在探讨BMI如何改变ACS患者NT-proBNP水平与临床结局之间的关联。

方法

共纳入北京友谊医院心血管中心的11757例ACS患者。使用多变量Cox比例风险模型评估NT-proBNP与主要不良心血管和脑血管事件（MACCE）之间的关联。使用Wald χ检验评估NT-proBNP与BMI之间的相乘交互作用。

结果

在3.04（四分位间距：1.07‒5.02）年的中位随访时间（33232人年）内，记录了1996例MACCE。观察到自然对数（Ln）-NT-proBNP与BMI之间存在显著的相乘交互作用（相乘交互作用的p值 = 0.013）。正常体重、超重和肥胖患者发生MACCE风险的NT-porBNP分类阈值分别为1559、155和419 pg/ml。当NT-proBNP水平接近正常或轻度升高（≤ 300 pg/ml）时，在给定的NT-proBNP水平下，超重和肥胖患者的事件发生概率高于正常体重患者。然而，在NT-proBNP水平显著升高（> 300 pg/ml）时观察到相反的趋势，正常体重患者的事件发生概率更高。当联合考虑BMI和NT-proBNP时，NT-proBNP升高的正常体重患者发生MACCE的风险显著高于NT-proBNP未升高的超重患者（风险比：2.28；95%置信区间：1.83‒2.84；p < 0.001）。