In patients after a recent ACS or stroke, postprandial MR-proANP dynamics are linked to insulin resistance rather than diabetes status, whereas NT-proBNP shows limited postprandial variability and copeptin changes are largely fasting-related, making these two markers less suited for capturing short-term metabolic responses.
Key Findings
Results
MR-proANP showed the most pronounced meal-induced suppression among the three peptides studied, while NT-proBNP showed only minor and inconsistent postprandial changes.
373 BeLOVE participants with acute coronary syndrome, stroke or very high chronic CV risk underwent standardized mixed-meal testing.
Fasting and 120-min postprandial concentrations of MR-proANP, NT-proBNP, copeptin, insulin and glucose were measured.
Testing took place about 3 months after the acute event, or 1 month after enrollment for the chronic high-risk group.
Results
For all three peptides, fasting concentrations were the main determinant of their postprandial changes.
Structural equation models were adjusted for age, sex and BMI.
The abstract states that fasting levels were the main determinant of postprandial change for MR-proANP, NT-proBNP and copeptin.
Results
A recent acute CV event was associated with higher fasting natriuretic peptide levels but not substantially with their postprandial changes after accounting for baseline levels.
MR-proANP: standardized β = 0.22 [0.09; 0.34].
NT-proBNP: standardized β = 0.28 [0.15; 0.41].
The association with postprandial change was not substantial once fasting levels were taken into account.
Results
Type 2 diabetes showed no consistent association with fasting or postprandial natriuretic peptide responses.
Structural equation models assessed direct and indirect associations of T2D with fasting levels and postprandial changes.
Models were adjusted for age, sex and BMI.
Results
Higher insulin resistance (HOMA-IR) was associated with lower fasting MR-proANP and a stronger postprandial MR-proANP decline.
Fasting MR-proANP: β = -0.19 [-0.30; -0.07].
Postprandial change in MR-proANP: β = -0.18 [-0.33; -0.04].
Adjusted for age, sex and BMI.
Results
Higher HOMA-IR was associated with lower fasting NT-proBNP but showed no clear association with its postprandial change.
Fasting NT-proBNP: β = -0.15 [-0.28; -0.03].
No clear association with postprandial NT-proBNP change.
Results
Copeptin dynamics were largely independent of acute cardiovascular disease and metabolic status.
Postprandial copeptin changes were largely fasting-related.
The authors conclude that NT-proBNP and copeptin are less suited than MR-proANP for capturing short-term metabolic responses.
Conclusions
The authors conclude that postprandial MR-proANP phenotyping may be a potential biomarker for cardiometabolic risk stratification, pending prospective outcome studies.
In patients after a recent ACS or stroke, postprandial MR-proANP dynamics are linked to insulin resistance rather than diabetes status.
The authors call for future prospective studies with cardiovascular outcomes in subjects with and without acute CV events.
What This Means
This study looked at how three blood markers used in heart disease care (MR-proANP, NT-proBNP and copeptin) change after a meal in 373 people who had recently had a heart attack or similar acute coronary event, a stroke, or who had very high long-term cardiovascular risk. Blood was taken fasting and two hours after a standard test meal. The researchers wanted to know whether a recent cardiovascular event, type 2 diabetes, or insulin resistance changes how these markers respond to eating.
MR-proANP dropped the most after the meal, while NT-proBNP changed little and inconsistently. For all three markers, the starting (fasting) level was the main factor determining how much they changed. A recent cardiovascular event was linked to higher fasting levels of the natriuretic peptides, but not clearly to how they changed after eating. Having type 2 diabetes was not consistently linked to either. Insulin resistance, however, was linked to lower fasting MR-proANP and a larger drop after the meal. Copeptin was largely unaffected by cardiovascular or metabolic status.
This research suggests that how MR-proANP responds to a meal may reflect insulin resistance more than diabetes status, and that it may be more informative than NT-proBNP or copeptin for studying metabolic responses. The study measured associations at one time point and did not follow patient outcomes. The authors say future studies that track cardiovascular outcomes are needed before this could be used in clinical practice.
Lishkova G, Schweizerhof O, Großmann J, von Rohr K, Landmesser U, Edelmann F, et al.. (2026). Meal-induced changes in cardiometabolic peptides in the context of acute cardiovascular diseases and glucose metabolism.. Cardiovascular diabetology. https://doi.org/10.1186/s12933-026-03424-5