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Body mass index in chronic heart failure: association with biomarkers of neurohormonal activation, inflammation and endothelial dysfunction

Heidi M Christensen1*, Morten Schou2, Jens P Goetze35, Jens Faber45, Jan Frystyk67, Allan Flyvbjerg67 and Caroline Kistorp4

Author Affiliations

1 Departments of Cardiology and Endocrinology, Herlev University Hospital, Ringvej 75, Herlev 2730, Denmark

2 Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

3 Department of Clinical Biochemistry, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark

4 Department of Endocrinology, Herlev University Hospital, Herlev, Denmark

5 Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark

6 Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark

7 The Medical Research Laboratories, Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark

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BMC Cardiovascular Disorders 2013, 13:80  doi:10.1186/1471-2261-13-80

Published: 1 October 2013



Low body mass index (BMI) is associated with a poor outcome in chronic heart failure (CHF). An inverse association between BMI and adiponectin and N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been reported. The aim of the present study was to investigate whether novel markers of neurohormonal activation, inflammation, and endothelial dysfunction are associated with BMI in CHF.


In a cross-sectional study including 171 patients with CHF and a left ventricular ejection fraction (LVEF) ≤45% the impact of BMI on circulating plasma concentrations of adiponectin, α-defensins, high sensitivity C-reactive protein (hsCRP), copeptin, mid-regional pro-adrenomedullin (MR-proADM), NT-proBNP, and mid-regional pro-A-type natriuretic peptide (MR-proANP) were evaluated.


In multivariable linear regression analysis including age, sex, LVEF, New York Heart Association functional classification (NYHA), estimated glomerular filtration rate (eGFR), and diabetes, only NT-proBNP (β = −0.32) and adiponectin (β = −0.39) remained independently associated with BMI. MR-proANP was associated with BMI but adjusting for age attenuated the relation being no longer significant.


Among biomarkers typically increased in patients with CHF only adiponectin and NT-proBNP demonstrated independent inverse associations with BMI. This indicates a direct effect of these two biomarkers enhancing the wasting process seen in CHF.

Biomarkers; Chronic heart failure; Body mass index