CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 1, January/February 2014
AFRICA
33
al
. Association between socioeconomic status and obesity in urban
Cameroon.
Int J Epidemiol
2006;
35
(1): 105–111.
36. Boyko EJ, Leonetti DL, Bergstrom RW, Newell-Morris L, Fujimoto
WY. Visceral adiposity, fasting plasma insulin, and lipid and lipoprotein
levels in Japanese Americans.
Int J Obes Relat Metab Disord
1996;
20
:
801–808.
37. Boyko EJ, Fujimoto WY, Leonetti DL, Newell-Morris L. Visceral
adiposity and risk of type 2 diabetes: a prospective study among
Japanese Americans.
Diabetes Care
2000;
23
: 465–471.
38. Hayashi T, Boyko EJ, Leonetti DL, McNeely MJ, Newell-Morris L,
Khan SE,
et al
. Visceral adiposity and the risk of impaired glucose
tolerance: a prospective study among Japanese Americans. 2003;
Diabetes Care
26
: 650–655.
39. Hayashi T, Boyko EJ, Leonetti DL, McNeely MJ, Newell-Morris L,
Khan SE,
et al
. Visceral adiposity is an independent predictor of inci-
dent hypertension in Japanese Americans.
Ann Intern Med
2004;
140
:
992–1000.
40. Wang Z, Ma J, Si D. Optimal cut-off values and population means of
waist circumference in different populations.
Nutr Res Rev
2010;
23
:
191–199.
41. Takahara M, Katakami N, Kaneto H, Noguchi M, Shimomura I.
Statistical reassessment of the association between waist circumfer-
ence and clustering metabolic abnormalities in Japanese population.
J
Atheroscler Thromb
2012;
19
: 767–778.
42. Hayashi T, Boyko EJ, Mc-Neely MJ, Leonetti DL, Khan SE, Fujimoto
WY. Minimum waist and visceral fat values for identifying Japanese
Americans at risk for the metabolic syndrome.
Diabetes Care
2007;
30
: 120–127.
Letter to the Editor
B-type natriuretic peptide for the prediction of left
ventricular remodelling
Dear Sir
We read with great interest the recent article by Choi
et al
.
1
on
the optimal time of B-type natriuretic peptide (BNP) sampling
for the prediction of left ventricular (LV) remodelling after
myocardial infarction (MI). Indeed, as underscored by Choi
et
al
., LV remodelling remains a significant clinical problem in the
modern era of MI management.
2
In addition, BNP is currently
the sole biomarker that has been convincingly associated with
LV remodelling in multiple studies (reviewed in Fertin
et al.
3
). It
is therefore important to determine the best window of time for
its determination in clinical practice.
Using multivariate analysis in a cohort of 131 patients,
the authors found that early levels (two to five days) of BNP
were associated with LV remodelling in fully adjusted models,
whereas late (three to four weeks) and long-term (six months)
levels were not. We previously reported on the usefulness of
serial (three to seven days, one, three and 12 months) assessment
of BNP to predict LV remodelling after MI in a prospective study
of 246 patients with a first anterior Q-wave MI.
4
Our results,
which were at variance from those of the study by Choi
et al
.,
demonstrated that BNP levels at any time point were associated
with LV remodelling; the association was mild at baseline and
stronger during follow up, particularly after three months.
With multivariate analysis, BNP retained its predictive value
at one, three and 12 months, but no longer at baseline. These
discrepancies between studies may be related to differences in
study populations and/or therapeutic management. It is also
important to know how missing values were handled when
comparing models at different time points. From the data
presented by Choi
et al
., it appears that BNP measurements at
six months were lacking in more than 20% of the cases. This
could theoretically have ‘disadvantaged’ BNP in late versus early
models.
At present, we believe that the optimal timing after MI for BNP
determination in clinical practice remains an unsettled question.
Christophe Bauters, MD,
Centre Hospitalier Régional et Universitaire de Lille, Lille;
Inserm U744, Institut Pasteur de Lille, Université de Lille 2,
Lille; Faculté de Médecine de Lille, Lille, France
Marie Fertin, MD
Florence Pinet, PhD
Centre Hospitalier Régional et Universitaire de Lille, Lille;
Inserm U744, Institut Pasteur de Lille, Université de Lille 2,
Lille
continued on page 39…
