Body Mass Index and Natriuretic Peptide Levels in Chronic Heart Failure: A Systematic Review

Aims To determine the relationship between B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) and body mass index in patients with chronic heart failure (HF). Methods Systematic review with narrative synthesis of original studies in adults with confirmed chronic HF that reported BNP or NT-proBNP stratified by BMI. Five databases were searched (June 2024); English-language full-text articles were included. Results We included 22 articles (21 studies; 24,460 patients, 36% female). Using each study’s own definitions, 11 articles (50%) enrolled patients with HF with reduced ejection fraction (HFrEF), 7 (32%) with preserved ejection fraction (HFpEF) and 4 (18%) a range of ejection fractions. Higher BMI was associated with lower BNP and/or NT-proBNP concentrations in 21 of 22 articles; one TOPCAT analysis reported a U-shaped relationship. Heterogeneity in BMI categories, HF definitions, assays and covariate adjustment precluded meta-analysis.. Conclusions This systematic review provides evidence for an inverse relationship between BMI and natriuretic peptides (NPs) in chronic heart failure suggesting that BMI is an important factor to consider when interpreting these natriuretic peptide concentrations. The clinical implication of these findings requires further investigation and may provide an opportunity to tailor approaches for risk stratification and treatment in this population.