N-Terminal Probrain Natriuretic Peptide Is a Stronger Predictor of Cardiovascular Mortality Than C-Reactive Protein and Albumin Excretion Rate in Elderly Patients With Type 2 Diabetes: The Casale Monferrato population-based study

• Published in: Diabetes care Vol. 36; no. 9; pp. 2677 - 2682
• Main Authors: BRUNO, Graziella, LANDI, Andrea, BARUTTA, Federica, GHEZZO, Giuseppe, BALDIN, Claudio, SPADAFORA, Laura, SCHIMMENTI, Andrea, PRINZIS, Tania, PERIN, Paolo Cavallo, GRUDEN, Gabriella
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.09.2013
• Subjects: Aged; Aged patients; Aged, 80 and over; Albumin; Analysis; Biological and medical sciences; C-reactive protein; C-Reactive Protein - metabolism; Cardiovascular disease; Cardiovascular Diseases - metabolism; Cardiovascular Diseases - mortality; Cholesterol; Diabetes; Diabetes Mellitus, Type 2 - metabolism; Diabetes Mellitus, Type 2 - mortality; Diabetes. Impaired glucose tolerance; Diabetics; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Humans; Male; Medical research; Medical sciences; Medicine, Experimental; Metabolic diseases; Middle Aged; Miscellaneous; Mortality; Natriuretic Peptide, Brain - metabolism; Natriuretic peptides; Original Research; Patient outcomes; Peptide Fragments - metabolism; Peptides; Prospective Studies; Proteins; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk factors; Type 2 diabetes; Endocrinopathy; Human; Type 2 diabetes; Excretion; Nutrition; Rate; Prediction; Albumin; Metabolic diseases; Cardiovascular disease; N terminal peptide; Statistical study; Predictive factor; C reactive protein; Elderly; Endocrinology
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc13-0353

To study whether N-terminal probrain natriuretic peptide (NT-proBNP) is a short-term independent predictor of both all-cause and cardiovascular (CV) mortality in type 2 diabetic patients and to establish whether albuminuria and C-reactive protein (CRP) affect this relationship. The prospective study included 1,825 type 2 diabetic patients from the population-based cohort of the Casale Monferrato study. CV risk factors, preexisting CVD, and NT-proBNP levels were evaluated at baseline. All-cause and CV mortality were assessed 5.5 years after baseline examination. Multivariate Cox proportional hazards modeling was used to estimate mortality hazard ratios (HRs). During the follow-up period, 390 people died (175 for CVD) out of 9,101 person-years of observations. A significantly increased mortality risk by quartiles of NT-proBNP was observed (test for trend, P < 0.001). NT-proBN P values >91 pg/mL conferred HRs of 2.05 (95% CI 1.47-2.86) for all-cause and 4.47 (2.38-8.39) for CV mortality, independently of CV risk factors, including CRP and albumin excretion rate (AER). The association was also significant for modest rises in NT-proBNP levels and in patients without microalbuminuria and CVD at baseline (upper quartiles HRs 3.82 [95% CI 1.24-13.75]) and 3.14 [1.00-9.94]). Albuminuria and NT-proBNP had an additive effect on mortality, though the association was stronger for NT-proBNP. NT-proBNP is a strong independent predictor of short-term CV mortality risk in elderly people with type 2 diabetes, including those without preexisting CVD. This association is evident even in people with slightly increased values, is not modified by CRP, and is additive to that provided by AER.