Low NT-proBNP levels associated with high Insulin resistance among healthy adults: JAMA

The results indicate that the mechanisms linking NT-proBNP to insulin resistance are partially independent of excess adiposity and may be associated with hyperinsulinemia.

"Sex-specific analyses in a cross-sectional study comprising a nationally representative sample of 4038 adults without diabetes and cardiovascular disease (CVD), revealed an association of lower NT-proBNP levels with increasing IR levels assessed using multiple approaches," the researchers reported. "The association persisted after rigorously accounting for dual-energy x-ray absorptiometry–derived lean and fat masses, waist circumference, and body mass index."

Using data from the 1999-2004 NHANES (National Health and Nutrition Examination Survey), Justin B. Echouffo-Tcheugui, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, and colleagues assessed the associations between measures of IR with NT-proBNP, accounting for measures of body composition (including DEXA-derived measures) in US adults.

The study included participants aged 20 years or older with measures of body mass index (BMI), NT-pro-BNP, and dual-energy x-ray absorptiometry (DEXA)–derived measures of body composition (fat and lean masses). The associations of measures of body mass and composition (lean mass, waist circumference, BMI, and fat mass) with NT-proBNP were characterized using linear and logistic regression.

After adjusting for CV risk factors and body composition measures, the associations of homeostasis model assessment of insulin resistance [HOMA-IR] and NT-proBNP were characterized using Linear regression. They also examined the triglyceride-glucose index [TyG index], quantitative insulin sensitivity check index [QUICKI], fasting insulin, triglyceride-glucose index [TyG index], and HOMA-β.

The study included 4038 adults without diabetes or cardiovascular disease (mean age, 44 years; 51.2% female; and 74.3% White).

The study led to the following findings:

• In sex-specific analyses, insulin resistance measures were inversely associated with NT-pro-BNP.
• After adjustment including cardiovascular risk factors, BMI, waist circumference, and DEXA-derived fat mass and lean mass, the per cent change in NT-proBNP associated with an SD increase in HOMA-IR was −16.84% in women and −19.04% in men.
• Similar associations were observed for other indices of insulin resistance, including QUICKI (women: 17.27 versus men: 22.17), TyG index women: −11.47 versus men: −15.81), IGR women: −15.15 versus men: −16.61), and fasting insulin (women: −16.32 versus men: −18.22), as well as HOMA-β (women: −10.71 versus men: −11.72).

"Further mechanistic studies of the insulin and natriuretic peptides links are an important next step toward understanding the pathobiology of natriuretic peptides," the researchers concluded.

Reference:

Echouffo-Tcheugui JB, Zhang S, McEvoy JW, et al. Insulin Resistance and N-Terminal Pro-B-Type Natriuretic Peptide Among Healthy Adults. JAMA Cardiol. Published online September 06, 2023. doi:10.1001/jamacardio.2023.2758