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Peer-reviewedCC BY 4.0Cardiovascular Diabetology

Meal-induced changes in cardiometabolic peptides in the context of acute cardiovascular diseases and glucose metabolism

  • G. Lishkova1,2,3
  • O. Schweizerhof4,5
  • J. Großmann1
  • K. von Rohr1,3
  • U. Landmesser2,4,6
  • F. Edelmann2,6,7
  • K. U. Eckardt8
  • M. Endres2,9,10,11,12
  • J. E. Weber2,4,9,10
  • U. Grittner5
  • T. Pischon13,14
  • J. Schulz-Menger2,6,7
4 more authors
  • D. N. Müller2,13,15
  • J. Spranger7
  • L. Li1,3,16
  • K. Mai1,2,3,16,17
17 affiliations
  1. 1Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, Corporate Member of the Freie Universität Berlin and Humboldt-Universität Berlin, ENDO-ERN, Berlin, Germany
  2. 2German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
  3. 3German Center for Diabetes Research (DZD), München-Neuherberg, Germany
  4. 4Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
  5. 5Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Corporate Member of the Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany
  6. 6Deutsches Herzzentrum der Charité (DHZC), Department of Cardiology, Angiology and Intensive Care Medicine, Campus Virchow Klinikum, Berlin, Germany
  7. 7Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany
  8. 8Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Corporate Member of the Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany
  9. 9Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of the Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany
  10. 10Center for Stroke Research (CSB), Charité-Universitätsmedizin Berlin, Corporate Member of the Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany
  11. 11German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Berlin, Germany
  12. 12German Center for Mental Health (DZPG), Partner Site Berlin, Berlin, Germany
  13. 13Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
  14. 14Biobank Technology Platform, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
  15. 15Experimental and Clinical Research Center, A Cooperation of Charité- Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, 13125 Berlin, Germany
  16. 16Department of Human Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
  17. 17Max Rubner Center for Cardiovascular Metabolic Renal Research, Charité- Universitätsmedizin Berlin, Corporate Member of the Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany
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Abstract

Background: Natriuretic peptides (NPs) and copeptin are established cardiovascular biomarkers which can partly affect human metabolism. However, impact of human metabolism on their postprandial regulation in high-risk patients remains insufficiently understood. We aimed to characterize meal-induced changes in MR-proANP, NT-proBNP, and copeptin and to assess how these dynamics relate to acute cardiovascular (CV) events, type 2 diabetes (T2D) and insulin resistance (IR).

Methods: Within the BeLOVE cohort, a subset of 373 participants with acute coronary syndrome, stroke or very high chronic CV risk underwent standardized study-specific mixed-meal testing approximately 3 months after the acute event or 1 month after enrollment for the chronic high-risk group. Fasting and 120-min postprandial concentrations of MR-proANP, NT-proBNP, copeptin, insulin and glucose were assessed. Structural equation models were used to evaluate direct and indirect associations of acute CV events, T2D, and IR (HOMA-IR) with fasting levels and postprandial changes, adjusted for age, sex and BMI.

Results: MR-proANP showed the most pronounced meal-induced suppression. NT-proBNP demonstrated only minor and inconsistent postprandial changes. For all peptides, fasting concentrations were the main determinant of their postprandial changes. A recent acute CV event was associated with higher fasting NP levels (MR-proANP: standardized β = 0.22 [0.09; 0.34]; NT-proBNP: β = 0.28 [0.15; 0.41]), but not substantially with their postprandial changes after accounting for their baseline levels. T2D showed no consistent association with fasting or postprandial NP responses. In contrast, higher HOMA-IR was associated with lower fasting MR-proANP (β=−0.19 [−0.30; −0.07]) and a stronger postprandial decline (β=−0.18 [−0.33; −0.04]). Similarly, higher HOMA-IR was linked to lower fasting NT-proBNP (β=−0.15 [−0.28; −0.03]) but showed no clear association to its postprandial change. Copeptin dynamics were largely independent of acute CV disease and metabolic status.

Conclusions: In patients after a recent ACS or stroke, postprandial MR-proANP dynamics are linked to insulin resistance, rather than diabetes status. In contrast, the limited postprandial variability of NT-proBNP and the largely fasting-related changes of copeptin make these markers less suited for capturing short-term metabolic responses. Together, these findings highlight the value of postprandial phenotyping for understanding cardiometabolic regulation and support further evaluation of MR-proANP as a potential biomarker in future prospective studies with cardiovascular outcomes across subjects with and without acute CV event.

Trial registration: The study protocol was approved by the institutional ethics committee (EA1/066/17) and registered in the German Clinical Trials Register (DRKS00016852).

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12933-026-03424-5.

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Cite

BibTeXRIS
BibTeX
@article{lishkova2026mealinduced,
  title = {{Meal-induced changes in cardiometabolic peptides in the context of acute cardiovascular diseases and glucose metabolism}},
  author = {G. Lishkova and O. Schweizerhof and J. Großmann and K. von Rohr and U. Landmesser and F. Edelmann and K. U. Eckardt and M. Endres and J. E. Weber and U. Grittner and T. Pischon and J. Schulz-Menger and D. N. Müller and J. Spranger and L. Li and K. Mai},
  journal = {Cardiovascular Diabetology},
  year = {2026},
  month = oct,
  doi = {10.1186/s12933-026-03424-5},
  url = {https://doi.org/10.1186/s12933-026-03424-5},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Meal-induced changes in cardiometabolic peptides in the context of acute cardiovascular diseases and glucose metabolism
AU  - G. Lishkova
AU  - O. Schweizerhof
AU  - J. Großmann
AU  - K. von Rohr
AU  - U. Landmesser
AU  - F. Edelmann
AU  - K. U. Eckardt
AU  - M. Endres
AU  - J. E. Weber
AU  - U. Grittner
AU  - T. Pischon
AU  - J. Schulz-Menger
AU  - D. N. Müller
AU  - J. Spranger
AU  - L. Li
AU  - K. Mai
PY  - 2026
DA  - 2026/10/26
JO  - Cardiovascular Diabetology
DO  - 10.1186/s12933-026-03424-5
UR  - https://doi.org/10.1186/s12933-026-03424-5
AB  - Background: Natriuretic peptides (NPs) and copeptin are established cardiovascular biomarkers which can partly affect human metabolism. However, impact of human metabolism on their postprandial regulation in high-risk patients remains insufficiently understood. We aimed to characterize meal-induced changes in MR-proANP, NT-proBNP, and copeptin and to assess how these dynamics relate to acute cardiovascular (CV) events, type 2 diabetes (T2D) and insulin resistance (IR).  Methods: Within the BeLOVE cohort, a subset of 373 participants with acute coronary syndrome, stroke or very high chronic CV risk underwent standardized study-specific mixed-meal testing approximately 3 months after the acute event or 1 month after enrollment for the chronic high-risk group. Fasting and 120-min postprandial concentrations of MR-proANP, NT-proBNP, copeptin, insulin and glucose were assessed. Structural equation models were used to evaluate direct and indirect associations of acute CV events, T2D, and IR (HOMA-IR) with fasting levels and postprandial changes, adjusted for age, sex and BMI.  Results: MR-proANP showed the most pronounced meal-induced suppression. NT-proBNP demonstrated only minor and inconsistent postprandial changes. For all peptides, fasting concentrations were the main determinant of their postprandial changes. A recent acute CV event was associated with higher fasting NP levels (MR-proANP: standardized β = 0.22 [0.09; 0.34]; NT-proBNP: β = 0.28 [0.15; 0.41]), but not substantially with their postprandial changes after accounting for their baseline levels. T2D showed no consistent association with fasting or postprandial NP responses. In contrast, higher HOMA-IR was associated with lower fasting MR-proANP (β=−0.19 [−0.30; −0.07]) and a stronger postprandial decline (β=−0.18 [−0.33; −0.04]). Similarly, higher HOMA-IR was linked to lower fasting NT-proBNP (β=−0.15 [−0.28; −0.03]) but showed no clear association to its postprandial change. Copeptin dynamics were largely independent of acute CV disease and metabolic status.  Conclusions: In patients after a recent ACS or stroke, postprandial MR-proANP dynamics are linked to insulin resistance, rather than diabetes status. In contrast, the limited postprandial variability of NT-proBNP and the largely fasting-related changes of copeptin make these markers less suited for capturing short-term metabolic responses. Together, these findings highlight the value of postprandial phenotyping for understanding cardiometabolic regulation and support further evaluation of MR-proANP as a potential biomarker in future prospective studies with cardiovascular outcomes across subjects with and without acute CV event.  Trial registration: The study protocol was approved by the institutional ethics committee (EA1/066/17) and registered in the German Clinical Trials Register (DRKS00016852).  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12933-026-03424-5.
SN  - 1475-2840
ER  -