B-type natriuretic peptide (BNP) is released by the cardiac ventricles in response to increased wall tension and cardiac stress, including cardiac ischemia and inflammation. BNP is synthesized as a prohormone that is cleaved into active BNP and an inactive N-terminal fragment (NT-pro-BNP).
Markedly elevated levels of NT-pro-BNP are diagnostic of congestive heart failure. Even mildly elevated levels of NT-pro-BNP lead to an increased risk of future adverse events. In the Ludwigshafen Risk and Cardiovascular Health Study, following 1,135 individuals with and 506 individuals without stable coronary artery disease (CAD) for 5.45 years, NT-pro-BNP concentrations of 100–399, 400-1,999, or >2,000 ng/L resulted in unadjusted hazard ratios (95% CI) for all-cause death of 3.2 (1.8 – 5.6), 6.63 (3.8 – 11.6), and 16.5 (9.2 – 29.8), respectively, compared with concentrations <100 ng/L. Hazard ratios (CI) for death from cardiovascular causes were 3.8 (1.8 – 8.2), 9.3 (4.4 – 19.5), and 22.2 (10.2 – 48.4).
Goal – < 125 pg/mL
What to do to improve it –
Galectin-3 mediated heart failure is common and accounts for 30-50% of heart failure patients. In patients with galectin-3 mediated heart failure, the wound healing response after cardiac injury goes beyond its natural end. The galectin-3 protein continues to activate the cells that form scar tissue, leading to excessive scarring and fibrosis. In these patients this fibrosis becomes diffuse and progressive, replacing normal heart muscle cells, resulting in changes in the shape and dimensions of the heart, known as adverse remodeling.
Goal – < 17.9 ng/mL
What to do to improve it – Use of Modified Citrus Pectin (MCP) has been shown to inhibit the deleterious effects of galectin-3. A diet rich in fruits and veggies has also been shown to reduce risk of heart failure by 37%, independent of other health benefits.
High-Definition Cardiac Troponin (cTnI)
Elevated Cardiac Troponin is found in acute disease states such as Myocardial Infarction, Angina, or Acute Coronary Syndrome. It is also found in several chronic disease states such as stable coronary artery disease, heart failure, cardiac inflammation, chronic kidney disease, non-cardiac valvular disease, respiratory disease, severe infection, and others. In an otherwise healthy population an elevated HD cTnI indicates adverse risk for future CV events, including AMI, death, and heart failure.
Causative Factors – Coronary Artery Disease, Hypertension, Heart Failure, valvular heart disease, arrhythmias, dyslipidemias, Diabetes, obesity, drug toxicity, autoimmune disorders, depression (untreated or under treated), chronic kidney disease, genetic disorders.
Goal – < 4.7 pg/mL
What to do to improve it –