NT-proBNP for Risk Prediction in Heart Failure:Identification of Optimal Cutoffs Across Body Mass Index Categories

OBJECTIVES The goal of this study was to assess the predictive power of N-terminal pro–B-type natriuretic peptide (NT-proBNP) and the decision cutoffs in heart failure (HF) across body mass index (BMI) categories. BACKGROUND  Concentrations of NT-proBNP predict outcome in HF. Although the influence of BMI to reduce levels of NT-proBNP is known, the impact of obesity on prognostic value remains uncertain. METHODS Individual data from the BIOS (Biomarkers In Heart Failure Outpatient Study) consortium were analyzed. Patients with stable HF were classified as underweight (BMI = 40 kg/m(2)) obese. The prognostic rote of NT-proBNP was tested for the endpoints of all-cause and cardiac death. RESULTS The study population included 12,763 patients (mean age 66 +/- 12 years; 25% women; mean left ventricular ejection fraction 33% 113%). Most patients were overweight (n = 5,176), followed by normal weight (n = 4,299), mildly obese (n = 2,157), moderately obese (n = 612), severely obese (n = 314), and underweight (n = 205). NT-proBNP inversely correlated with BMI (beta = -0.174 for 1 kg/m(2); P < 0.001). Adding NT-proBNP to clinical models improved risk prediction across BMI categories, with the exception of severely obese patients. The best cutoffs of NT-proBNP for 5-year all-cause death prediction were lower as BMI increased (3,785 ng/L, 2,193 ng/L, 1,554 ng/L, 1,045 ng/L, 755 ng/L, and 879 ng/L, for underweight, normal weight, overweight, and mildly, moderately, and severely obese patients, respectively) and were higher in women than in men. CONCLUSIONS NT-proBNP maintains its independent prognostic value up to 40 kg/m(2) BMI, and tower optimal risk-prediction cutoffs are observed in overweight and obese patients

What's New in the New Regionalism in the Americas?

The centrifugal forces of economic globalization in the 1990's ran parallel with centripetal forces of regionalization. While seemingly pulling in opposite directions, the two forces reflected complementary dimensions of dynamic capitalist market development. The completion of the Uruguay Round and growing membership in the World Trade Organization (WTO) was accompanied by a situation in which regional integration schemes became commonplace; indeed, practically all WTO members are now party to one or more regional accords. Latin America is a good example of these dual forces. Between the mid-1980s and 1990s the region unilaterally reduced its average external tariff from over 40% to 12 %. The region also actively participated in the Uruguay Round and by the end of the decade all Latin American countries were members of the WTO. Meanwhile, there was a parallel wave of new reciprocal free trade and integration agreements, around twenty in number. These trends were accompanied by a strong average growth of international trade in the 1990s and a marked increase in intraregional trade. This paper attempts to substantiate that Latin America¿s recent wave of regional integration is indeed a New Regionalism, quite different from the old, and hence merits a more comprehensive perspective than in the past

The Trade and Cooperation Nexus: How Does the MERCOSUR-EU Process Measure Up?

The objective of this study is to analyze the interaction between trade and non-trade cooperation in some of the today's major regional initiatives, particularly those between developing and industrialized countries. The study suggests a framework to explore what the paper calls a "trade and cooperation nexus". The modalities of this nexus can take different forms. For instance, non-trade cooperation may be an integral part of a formal trade or integration agreement, or may take place independently of such an agreement, as an ex-ante, ex-post or parallel agreement. This paper analyzes the EU approach, which proposes an unusually tight trade and cooperation nexus based on a three-pillar approach uniting political, economic and trade cooperation under a single umbrella agreement. Theoretically this approach should be attractive, especially in North-South agreements, because the promise of linking free trade with cooperation programs could enhance the benefits of the former for both parties. However, while innovative, the nexus is challenging in its construction and delivery. The paper will explore EU efforts in this area in the broader context of what is happening in other North-South initiatives

El impacto de China: Oportunidades y retos para América Latina y el Caribe

¿Cómo puede América Latina aprovechar al máximo las oportunidades que ofrece el mercado chino y preparar al mismo tiempo a sus economías para hacer frente al desafío competitivo de China? Esta obra pionera, producida por el Departamento de Integración y Programas Regionales y el Departamento de Investigación del BID, trata de dar algunas respuestas. Presenta un panorama completo de la política económica de China y su desempeño en las últimas décadas y lo compara con la experiencia de América Latina. Asimismo, analiza los factores determinantes de su ventaja competitiva y las repercusiones estratégicas de su ascenso en el crecimiento y el desarrollo de la región latinoamericana.

Integration and Trades in the Americas: Special Issue on Latin America and the Caribbean Economic Relations with Asia-Pacific

The purpose of this document is to inform Bank staff and other interested parties about recent developments in integration and trade among the countries of the Western Hemisphere and between these and other countries and world regions

Integración y comercio en las Américas: Edición especial: Las relaciones económicas entre América Latina y el Caribe y la región Asia-Pacífico

El objetivo de este documento es informar al personal del Banco, así como a otros interesados sobre los últimos desarrollos en integración y comercio en los países del Hemisferio Occidental, y, entre éstos y otros países y regiones del mundo. El propósito de esta publicación es (1) evaluar el estado actual de las relaciones económicas entre América Latina y el Asia-Pacífico; (2) examinar la evolución de las iniciativas de cooperación bilateral; (3) analizar las contribuciones potenciales de las estrategias de desarrollo asiáticas a las políticas económicas de los países de América Latina; y (4) explorar nuevas posibilidades de la relación birregional

Integration and Trades in the Americas: Special Issue on Latin America and the Caribbean Economic Relations with Asia-Pacific

The purpose of this document is to inform Bank staff and other interested parties about recent developments in integration and trade among the countries of the Western Hemisphere and between these and other countries and world regions.Land management  & registration, Social Development, Urban Development, Heritage Conservation, Economic Ties, Cooperation and Development Strategies

Bridges for Development: Policies and Institutions for Trade and Integration

This book analyzes the role of trade as a central pillar of the structural reform process and a bridge to capturing the dynamic development forces of an increasingly globalized world economy