NT-proBNP has a high negative predictive value to rule-out short-term cardiovascular events in patients with diabetes mellitus

Huelsmann, M; Neuhold, Stephanie; Strunk, Guido; Moertl, Deddo; Berger, Rudolf; Prager, Rudolf; Abrahamian, Heidemarie; Riedl, Michaela; Pacher, Richard; Luger, Anton; Clodi, Martin

doi:10.1093/eurheartj/ehn334

Cited by 68 publications

(75 citation statements)

References 29 publications

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“…8) Huelsmann, et al have shown that DM subjects with NT-proBNP levels less than 125 pg/mL had an excellent short-term prognosis for unplanned hospitalization for CV events and death. 5) These previous single center studies were performed under specialist diabetes care and did not identify the threshold level of plasma BNP indicating increased risk of CV events. In a general practical context where health care providers are usually caring for large numbers of patients with DM, it would be helpful to be able to identify individuals at high risk of CV events by a reliable and simple blood test.…”

Section: Discussionmentioning

confidence: 99%

“…27) Second, mean BMI was lower in our study than in previous DM populations. 5,8) Cardiac natriuretic peptides in plasma have been reported to be lower in subjects with obesity and insulin resistance than in nonobese and insulin sensitive subjects. 23) Consequently, threshold BNP levels may be lower in a predominantly obese DM population.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8][9] Although such a simple risk screening approach in the DM population may be more helpful for general practitioners or health care providers as a signal for commencement of evidence-based interventions for DM, the specific value of plasma BNP for predicting increased CV risk in unselected DM subjects in a communitybased population has yet to be established. Moreover, no studies have examined the effects of adding plasma BNP testing to a traditional CV risk prediction model in these subjects.…”

Section: Bnp and CV Risk In Dm In Communitymentioning

confidence: 99%

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Plasma B-Type Natriuretic Peptide Is Useful for Cardiovascular Risk Assessment in Community-Based Diabetes Subjects

et al. 2012

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SummaryDiabetes mellitus (DM) is a strong risk factor for cardiovascular (CV) disease. Plasma B-type natriuretic peptide (BNP) levels are elevated in various types of cardiac diseases. Increased plasma BNP levels have been reported to be associated with CV risk in apparently healthy individuals. However, no studies have yet examined the specific value of plasma BNP for predicting CV incidence in unselected DM subjects in a community-based population.In a community-based DM cohort (n = 1,059, mean = 66 years), baseline BNP levels were determined, and CV events were followed and captured prospectively. The cohort was divided by plasma BNP quintiles. The Cox proportional hazard model was used to determine the relative hazard ratios (HR) among the quintiles. In addition, the effects of adding the plasma BNP or urine albumin-to-creatinine ratio (UACR) to an established CV risk scoring model was examined by calculating the area under the receiver operating characteristic (ROC) curve (AUC).During the 5.7 year follow-up period, CV events were identified in 65 of the DM cohort. There was a significant association between plasma BNP levels and CV event rate (P < 0.001). HR was significantly increased in the highest quintile compared to the lowest (HR = 4.38; 95%CI 1.69 -11.84). The AUC generated from ROC analysis of the Framingham risk score for predicting general CV events was improved by adding BNP testing (from 0.66 to 0.74; P = 0.05), but not by adding UACR (from 0.66 to 0.67; P = 0.49).In a community sample of people with DM, plasma BNP levels above the 80 percentile are directly associated with CV risk, and measurement of plasma BNP alone or in conjunction with an established CV risk score is of value in predicting CV events in these subjects. (Int Heart J 2012; 53: 176-181)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Bnp and CV Risk In Dm In Communitymentioning

confidence: 99%

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Plasma B-Type Natriuretic Peptide Is Useful for Cardiovascular Risk Assessment in Community-Based Diabetes Subjects

et al. 2012

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“…To date, most studies investigating the predictive value of NT-proBNP in diabetic patients have been limited, for example by small sample sizes [13,14], predominantly male samples [15] or a short follow-up period [16]. One recently published study [17] suggests that NT-proBNP is a strong independent predictor of cardiovascular mortality in unselected older patients with type 2 diabetes; however, 36% of the cohort was below 65 years of age at baseline and the results did not include non-fatal cardiovascular events.…”

Section: Introductionmentioning

confidence: 99%

N-terminal pro-brain natriuretic peptide and risk of cardiovascular events in older patients with type 2 diabetes: the Edinburgh Type 2 Diabetes Study

et al. 2014

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Aims/hypothesis The aim of this study was to investigate the association of N-terminal pro-brain natriuretic peptide (NTproBNP) with traditional cardiovascular risk factors and incident cardiovascular events in older people with type 2 diabetes. Methods In the prospective phase of the Edinburgh Type 2 Diabetes Study, 1066 men and women aged 60 to 75 years with type 2 diabetes mellitus were followed for 4 years; 112 participants had an incident cardiovascular event. At baseline, cardiovascular risk factors, pre-existing cardiovascular disease and levels of NT-proBNP were evaluated. Results Raised plasma NT-proBNP levels were associated with these classical cardiovascular risk factors: increased duration of diabetes, use of insulin, raised BMI, reduced HDLcholesterol, reduced renal function and use of lipid-lowering and anti-hypertensive medication (all p < 0.05). In the prospective analysis, NT-proBNP was strongly associated with subsequent risk of all cardiovascular disease events (HR per one SD increase in NT-proBNP 1.39; 95% CI 1.10, 1.75), independent of cardiovascular risk factors traditionally used to predict vascular events. NT-proBNP was also independently associated with incident coronary artery disease events (1.48, 95% CI 1.10, 1.98). The addition of NTproBNP to multivariate models improved the C-index by 0.019 for the 'hard' cardiac endpoint (fatal and non-fatal myocardial infarction). Conclusions/interpretation In older people with type 2 diabetes, NT-proBNP is associated with the development of coronary and cerebrovascular events, independent of a wide range of other vascular and metabolic risk factors, and may prove a useful addition to current vascular risk scores in diabetes populations.

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“…After our publications on this topic (2,3) and the Casale Monferrato Study (4), this is now the third well-adjusted cohort showing the ability of NT-proBNP as a risk marker for cardiovascular disease in this setting. We agree that the clinical relevance still has to be proven in future trials.…”

mentioning

confidence: 95%

Comment on Hillis et al. The Relative and Combined Ability of High-Sensitivity Cardiac Troponin T and N-Terminal Pro-B-Type Natriuretic Peptide to Predict Cardiovascular Events and Death in Patients With Type 2 Diabetes. Diabetes Care 2014;37:295–303

2014

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NT-proBNP has a high negative predictive value to rule-out short-term cardiovascular events in patients with diabetes mellitus

Cited by 68 publications

References 29 publications

Plasma B-Type Natriuretic Peptide Is Useful for Cardiovascular Risk Assessment in Community-Based Diabetes Subjects

Plasma B-Type Natriuretic Peptide Is Useful for Cardiovascular Risk Assessment in Community-Based Diabetes Subjects

N-terminal pro-brain natriuretic peptide and risk of cardiovascular events in older patients with type 2 diabetes: the Edinburgh Type 2 Diabetes Study

Comment on Hillis et al. The Relative and Combined Ability of High-Sensitivity Cardiac Troponin T and N-Terminal Pro-B-Type Natriuretic Peptide to Predict Cardiovascular Events and Death in Patients With Type 2 Diabetes. Diabetes Care 2014;37:295–303

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