Prognostic role of B-type natriuretic peptide levels in patients with type 2 diabetes mellitus

Bhalla, Meenakshi; Chiang, Audrey; Epshteyn, Victoria A.; Kazanegra, Radmila; Bhalla, Vikas; Clopton, Paul; Krishnaswamy, Padma; Morrison, L.Katherine; Chiu, Albert; Gardetto, Nancy; Mudaliar, Sunder; Edelman, Steven V.; Henry, Robert R.; Maisel, Alan S.

doi:10.1016/j.jacc.2004.05.071

Cited by 93 publications

(56 citation statements)

References 34 publications

(18 reference statements)

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“…In accord with a study of male type 2 diabetic veterans [32], and also based on one measurement, our cohort study of type 2 diabetic patients suggests that in clinical practice BNP and NT-proBNP could be useful for the identification of patients with a hitherto unknown high risk of death. These patients might benefit from even more aggressive management of established cardiovascular risk factors and selective referral for further cardiology follow-up.…”

Section: Discussionsupporting

confidence: 73%

“…The use of natriuretic peptides in screening programmes for preclinical left ventricular dysfunction in community settings has been debated [27,28]. However, in high-risk diabetic populations, measurements of BNPs suggest the presence of left ventricular hypertrophy [29,30] and diastolic and systolic dysfunction [31], and predict future cardiovascular morbidity [7] and mortality (present study) [6,32]. Data on heart function are limited in the present study, since echocardiographies were not performed and the prevalence of ECG-detected left ventricular hypertrophy is low.…”

Section: Discussionmentioning

confidence: 93%

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Plasma N-terminal pro-B-type natriuretic peptide and mortality in type 2 diabetes

et al. 2006

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Aims/hypothesis Raised N-terminal pro-B-type natriuretic peptide (NT-proBNP) is associated with a poor cardiac outcome in non-diabetic populations. Elevated NT-proBNP predicts excess morbidity and mortality in diabetic patients with an elevated urinary albumin excretion rate. This study investigated the prognostic value of NT-proBNP in a cohort of type 2 diabetic patients. Subjects, materials and methods In a prospective observational follow-up study, 315 type 2 diabetic patients with normoalbuminuria (n=188), microalbuminuria (n=80) and macroalbuminuria (n=47) at baseline were followed for a median (range) of 15.5 (0.2-17.0) years. Plasma NTproBNP concentrations were determined by immunoassay at baseline. Endpoints were overall and cardiovascular mortality. Results Of the patients, 162 died (51%), 119 of them (74%) due to cardiovascular causes. All-cause mortality was increased in patients with NT-proBNP .02], p=0.01). When patients with normo-, micro-and macroalbuminuria were analysed separately, NT-proBNP levels above the median (62 ng/l) were consistently associated with increased overall and cardiovascular mortality in all three groups (p<0.001). Conclusions/interpretation In patients with type 2 diabetes, elevated circulating NT-proBNP is a strong predictor of the excess overall and cardiovascular mortality, this predictor status being independent of urinary albumin excretion rate and conventional cardiovascular risk factors.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 93%

Plasma N-terminal pro-B-type natriuretic peptide and mortality in type 2 diabetes

et al. 2006

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“…The effects on BNP are unlikely to be a chance finding; similar effects were seen with vitamin D supplementation in a trial of older patients with chronic heart failure due to left ventricular systolic dysfunction [33]. BNP is known to be a significant predictor of future cardiovascular and all-cause mortality in patients with type 2 diabetes [34]; thus interventions that improve this marker could potentially confer prognostic benefits.…”

Section: Discussionmentioning

confidence: 93%

The effect of different doses of vitamin D3 on markers of vascular health in patients with type 2 diabetes: a randomised controlled trial

et al. 2010

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Aims/hypothesis Low 25-hydroxyvitamin D levels predict future cardiovascular events and are common in patients with type 2 diabetes. We compared the effect of 100,000 and 200,000 IU doses of vitamin D 3 on endothelial function, blood pressure and markers of glycaemic control in patients with type 2 diabetes. Methods This was a randomised, parallel group, placebocontrolled trial. Patients with type 2 diabetes and baseline 25-hydroxyvitamin D levels <100 nmol/l were enrolled from community and hospital-based diabetes clinics. Participants were assessed in a university department of clinical pharmacology and received a single oral dose of placebo or vitamin D 3 (100,000 IU or 200,000 IU) at baseline, randomly allocated via numbered bottles prepared offsite; participants and investigators were both blinded to treatment allocation. Endothelial function, office blood pressure, B-type natriuretic peptide, insulin resistance and glycosylated haemoglobin were measured at baseline, and at 8 and 16 weeks.

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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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Prognostic role of B-type natriuretic peptide levels in patients with type 2 diabetes mellitus

Abstract: B-type natriuretic peptide appears to be a reliable predictor of future cardiac and all-cause mortality in diabetic patients.

Cited by 93 publications

References 34 publications

Plasma N-terminal pro-B-type natriuretic peptide and mortality in type 2 diabetes

Plasma N-terminal pro-B-type natriuretic peptide and mortality in type 2 diabetes

The effect of different doses of vitamin D3 on markers of vascular health in patients with type 2 diabetes: a randomised controlled trial

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

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