ProBNP processing is decreased by obesity in patients with heart failure

We thank Doctors Parcha and Arora (1), and Nishikimi and Nakagawa (2) for their interest in our study reporting that proBNP not glycosylated at threonine 71 (T71) was decreased in obese patients with chronic heart failure (3). We appreciate these authors taking the time to provide well-constructed overviews of the current literature relating to processing of proBNP and the known links between NT-proBNP and BNP and obesity. While BNP and NT- proBNP measurement is mandated in the diagnosis and risk stratification of heart failure (4), levels of these peptides are decreased with obesity, complicating their use in the clinical assessment of heart failure in obese individuals (5). The reasons for this decrease have not been adequately explained although many theories have been debated (2,3).