Increases in Natriuretic Peptides Precede Heart Failure Hospitalization in Patients With a Recent Coronary Event and Type 2 Diabetes Mellitus
2017; Lippincott Williams & Wilkins; Volume: 136; Issue: 16 Linguagem: Inglês
10.1161/circulationaha.117.029503
ISSN1524-4539
AutoresEmil Wolsk, Brian Claggett, Rafael Díaz, Kenneth Dickstein, Hertzel C. Gerstein, Lars Køber, Francesca Lawson, Eldrin F. Lewis, Aldo P. Maggioni, John J.V. McMurray, Jeffrey L. Probstfield, Matthew C. Riddle, Scott D. Solomon, Jean‐Claude Tardif, Marc A. Pfeffer,
Tópico(s)Pancreatic function and diabetes
ResumoHomeCirculationVol. 136, No. 16Increases in Natriuretic Peptides Precede Heart Failure Hospitalization in Patients With a Recent Coronary Event and Type 2 Diabetes Mellitus Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBIncreases in Natriuretic Peptides Precede Heart Failure Hospitalization in Patients With a Recent Coronary Event and Type 2 Diabetes Mellitus Emil Wolsk, MD, PhD, Brian Claggett, PhD, Rafael Diaz, MD, Kenneth Dickstein, MD, PhD, Hertzel C. Gerstein, MD, Lars Køber, MD, Francesca C. Lawson, MD, Eldrin F. Lewis, MD, MPH, Aldo P. Maggioni, MD, John J. V. McMurray, MD, PhD, Jeffrey L. Probstfield, MD, Matthew C. Riddle, MD, Scott D. Solomon, MD, Jean-Claude Tardif, MD and Marc A. Pfeffer, MD, PhD Emil WolskEmil Wolsk From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.). , Brian ClaggettBrian Claggett From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.). , Rafael DiazRafael Diaz From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.). , Kenneth DicksteinKenneth Dickstein From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.). , Hertzel C. GersteinHertzel C. Gerstein From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.). , Lars KøberLars Køber From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.). , Francesca C. LawsonFrancesca C. Lawson From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.). , Eldrin F. LewisEldrin F. Lewis From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.). , Aldo P. MaggioniAldo P. Maggioni From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.). , John J. V. McMurrayJohn J. V. McMurray From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.). , Jeffrey L. ProbstfieldJeffrey L. Probstfield From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.). , Matthew C. RiddleMatthew C. Riddle From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.). , Scott D. SolomonScott D. Solomon From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.). , Jean-Claude TardifJean-Claude Tardif From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.). and Marc A. PfefferMarc A. Pfeffer From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W., B.C., E.F.L., S.D.S., M.A.P.); Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (E.W., L.K.); Estudios Clínicos Latinoamérica, Rosario, Argentina (R.D.); University of Bergen, Stavanger University Hospital, Norway (K.D.); Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada (H.C.G.); Sanofi US, Bridgewater, NJ (F.C.L.); Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy (A.P.M.); British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.); Division of Cardiology, University of Washington Medical Center, Seattle (J.L.P.); Division of Endocrinology, Oregon Health and Science University, Portland (M.C.R.); and Montreal Heart Institute, Université de Montréal, Quebec, Canada (J.-C.T.). Originally published17 Oct 2017https://doi.org/10.1161/CIRCULATIONAHA.117.029503Circulation. 2017;136:1560–1562Patients with a recent coronary event are at high risk of further cardiovascular events, including hospitalization for heart failure (HFH).1,2 Knowledge of the pathophysiological changes preceding HFH provides insight into the temporal course of the progression of HF and may help identify those at imminent risk of this event. B-type natriuretic peptide (BNP) and NT-proBNP (N-terminal prohormone BNP) change rapidly in relation to changes in filling pressures and wall stress, making them useful for monitoring clinical status and response to treatment and clinical status in HF.3 Because there are limited data on temporal changes in natriuretic peptides (NPs) preceding HFH, we examined concentrations of NPs preceding HFH in patients with a recent coronary event and type 2 diabetes mellitus enrolled in the ELIXA trial [Evaluation of Cardiovascular Outcomes in Patients With Type 2 Diabetes After Acute Coronary Syndrome During Treatment With AVE0010 (Lixisenatide); NCT01147250].The design and primary findings of ELIXA have been published.4 A total of 6068 patients with type 2 diabetes mellitus and an acute coronary syndrome (index event) occurring within 180 days of randomization were enrolled. The trial was designed to assess the efficacy and safety of lixisenatide, a glucagon-like peptide-1 receptor agonist, with respect to cardiovascular morbidity and mortality.5 Sampling of BNP and NT-proBNP occurred at baseline and at weeks 24, 76, and 108 after randomization, yielding 19 585 samples. Samples were collected and analyzed at a core laboratory (Covance Central Laboratory Services, Meyrin, Switzerland). ELIXA was approved by appropriate institutional or central review boards. All participants provided written informed consent.For our analyses, patients with both a baseline and a week 24 NP sample without an intervening HFH were included. This yielded 5450 patients (90% of randomized patients) for analysis, of whom 22% reported a history of HF before randomization. To describe the temporal trajectory of NP levels before HFH, a retrospective analysis was developed using repeated measures regression models with restricted cubic splines. The timescale used was the number of days before HFH or end of follow-up and relied on prespecified trial visits to minimize confounding between patient health and timing of ascertainment of NP concentrations. This allowed us to estimate the average trajectory of NP concentrations that would have been observed if patients had been continuously monitored. NP data were log-transformed and summarized with geometric means (±95% confidence interval).Patients had a mean±SD age of 60±10 years, body mass index of 30±6 kg/m2, and estimated glomerular filtration rate of 76±24 mL·min−1·1.73 m−2. Of the 5450 included patients, 151 (3%) subsequently experienced HFH during a median follow-up of 26 months. The NP concentrations of patients who did not experience HFH declined continuously during follow-up after their index acute coronary syndrome. NP concentrations were significantly greater when measured closer to the time of the event in those who experienced HFH (all patients, data not shown; BNP, P<0.001; NT-proBNP, P<0.001). The estimated rates of monthly increase in NP levels were 1% to 2% from 12 to 6 months before HFH, increasing to ≈8% and 11% per month over the final 6 months for BNP and NT-proBNP, respectively. Increases in NP were also evident preceding other outcomes examined (death, cardiovascular death, myocardial infarction, stroke), but the magnitude of increase was notably less than for HFH.The overall increase in NP among patients experiencing HFH during follow-up was most prominent among patients without a history of HF (Figure). Patients without a history of HF had an increase (≈3- to 4-fold) in NP preceding HFH that was greater than that in patients with a history of HF at randomization (≈50% increase; P for interaction=0.029 for BNP and 0.067 for NT-proBNP).Download figureDownload PowerPointFigure. Geometric mean natriuretic peptide (NP) levels before heart failure (HF) hospitalization (HFH). Left, All patients (top, B-type NP [BNP]; bottom, NT-proBNP [N-terminal prohormone BNP]). Histogram represents number of NP samples available for HFH and control patients by 30-day increments. Middle, Patients with no history of HF at randomization (top, BNP; bottom, NT-proBNP). Right, Patients with a history of HF at randomization (top, BNP; bottom, NT-proBNP).There were 5% to 7% reductions at week 24 in BNP (P=0.011) and NT-proBNP (P=0.001) associated with randomization to lixisenatide. These relative reductions did not differ between those who later did and those who did not experience HFH, and the temporal pattern of increases in NP before HFH did not differ by treatment allocation (BNP, P=0.23; NT-proBNP, P=0.08).In patients with a recent acute coronary syndrome and type 2 diabetes mellitus, increases in NPs were evident in the months preceding HFH. It was estimated that patients without a history of HF experienced a progressive increase in NP levels (≈3- to 4-fold), with accelerated increase during the final 6 months before HFH, whereas patients with a history of HF experienced relatively steady NP levels until ≈6 months before HFH, followed by similar increases during the final months. At the time of HFH, patients with and without a history of HF reached comparable NP levels. These changes elucidate important differences between patients with and without a history of HF who experience HFH. These findings suggest that cardiac deterioration is progressing several months before HFH, potentially enabling earlier identification of patients on a trajectory toward HFH. The translation of these observations into guidance on the optimal frequency of NP monitoring or clinically relevant NP changes over specific time intervals for predictive purposes remains to be determined.Emil Wolsk, MD, PhD*Brian Claggett, PhD*Rafael Diaz, MDKenneth Dickstein, MD, PhDHertzel C. Gerstein, MDLars Køber, MDFrancesca C. Lawson, MDEldrin F. Lewis, MD, MPHAldo P. Maggioni, MDJohn J. V. McMurray, MD, PhDJeffrey L. Probstfield, MDMatthew C. Riddle, MDScott D. Solomon, MDJean-Claude Tardif, MDMarc A. Pfeffer, MD, PhDDisclosuresDr Wolsk is supported by unrestricted grants from The Danish Council for Independent Research (4183-00550), Fonden af 17-12-1981, Eva & Henry Frænkels Mindefond, Kong Christian den Tiendes Fond, Knud Højgaards Fond, and Direktør Ib Henriksens Fond. Dr Pfeffer received research grant support from Novartis and Sanofi; received consultant fees from AstraZeneca, Bayer, Boehringer Ingelheim, DalCor, Genzyme, Gilead, GlaxoSmithKline, Janssen, Lilly, The Medicines Company, Merck, Novartis, Novo Nordisk, Relypsa, Sanofi, Teva, and Thrasos; has stock options in DalCor; and has a patent awarded to Brigham and Women's Hospital for the use of inhibitors of the renin-angiotensin system in myocardial infarction. Licensed by Novartis, Dr Pfeffer's share is irrevocably assigned to charity. Dr Diaz received grants from Sanofi. Dr Dickstein is a member of the ELIXA Executive Steering Committee and is supported by the McMaster-Sanofi Population Health Institute Chair in Diabetes Research and Care. Dr Gerstein has received research grant support from Sanofi, Lilly, AstraZeneca, and Merck; honoraria for speaking from Sanofi, Lilly, Novo Nordisk, AstraZeneca, and Berlin Chemie; and consulting fees from Sanofi, Lilly, AstraZeneca, Merck, Novo Nordisk, Abbot, Amgen, Boehringer Ingelheim, and Kaneq Bioscience. Dr Lawson is a Sanofi employee. Dr Lewis received research support from Sanofi. Dr Maggioni has received honoraria for participation in the ELIXA Executive/Steering Committee sponsored by Sanofi. Dr Riddle has received research support through his institution and honoraria for consulting from AstraZeneca and Eli Lilly; honoraria for consulting from Elcelyx, GlaxoSmithKline, Theracos, and Valeritas: research support through his institution from NovoNordisk; research support through his institution and honoraria for consulting and for speaking at professional meetings from Sanofi. Dr Solomon has received research support from Sanofi. Dr Tardif has received research grants from Amarin, AstraZeneca, DalCor, Eli Lilly, Esperion, Merck, Pfizer, Sanofi, and Servier; has received honoraria from DalCor, Pfizer, Sanofi, and Servier; and holds a minor equity interest in DalCor. Dr Køber reports receiving personal fees from Sanofi and Novartis as speaker. The other authors report no conflicts.Footnotes*Drs Wolsk and Claggett contributed equally.The podcast and transcript are available as an online-only Data Supplement at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/CIRCULATIONAHA.117.029503/-/DC1.Circulation is available at http://circ.ahajournals.org.Correspondence to: Brian Claggett, PhD, Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. E-mail [email protected]References1. Jhund PS, McMurray JJ, Chaturvedi N, Brunel P, Desai AS, Finn PV, Haffner SM, Solomon SD, Weinrauch LA, Claggett BL, Pfeffer MA. 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October 17, 2017Vol 136, Issue 16 Advertisement Article InformationMetrics © 2017 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.117.029503PMID: 29038210 Originally publishedOctober 17, 2017 Keywordsnatriuretic peptidesheart failurePDF download Advertisement SubjectsHeart Failure
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