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Elevated Plasma Levels of Nt-proBNP in Patients With Type 2 Diabetes Without Overt Cardiovascular Disease

¹ Department of Cardiology, University Hospital MAS, Lund University, Sweden
² Department of Endocrinology, University Hospital MAS, Lund University, Lund, Sweden
³ Department of Clinical Chemistry, University Hospital in Lund, Lund University, Lund, Sweden
⁴ Cardiovascular Research Group, Wallenberg Laboratory University Hospital MAS, Lund University, Lund, Sweden
⁵ Lund Strategic Research Center for Stem Cell Biology and Cell Therapy, Lund, Sweden

Address correspondence to Dr. Stefan Jovinge, Department of Cardiology, Ing 35 Univ Hosp MAS, S-205 02 Malmö, Sweden. E-mail: stefan.jovinge{at}stemcell.lu.se

OBJECTIVE—The NH₂-terminal portion of the precursor of brain natriuretic peptide (Nt-proBNP) has been reported to be elevated in left ventricular dysfunction. This peptide is a split product from the proBNP molecule, and its level in the circulation is not, as the mature BNP peptide, dependent on the peripheral number of BNP receptors. We aimed to test the hypothesis that asymptomatic left ventricular dysfunction (ALVD), as estimated by Nt-proBNP, would be more prevalent in patients with type 2 diabetes without overt cardiovascular disease in comparison with matched control subjects.

RESEARCH DESIGN AND METHODS—The study population consisted of 253 patients with type 2 diabetes and 230 matched control subjects aged 40–70 years without any overt heart disease from primary care centers in Western Finland and Southern Sweden. Nt-proBNP was measured in plasma by competitive enzyme immunosorbent assay.

RESULTS—Patients with type 2 diabetes were shown to have higher Nt-proBNP values (360.9 pmol/l [262.6–467.9]) than control subjects (302.7 pmol/l [215.4–419.2]) (P < 0.001). Nt-proBNP levels were independently related to diabetes after adjustment for age, sex, systolic and diastolic blood pressure, BMI, heart rate, drug treatment, serum creatinine, and cystatin C.

CONCLUSIONS—Our data suggest that the secretion of Nt-proBNP is increased in type 2 diabetic patients with no overt heart disease, suggesting that type 2 diabetes is associated with a higher prevalence of ALVD than hitherto thought. Nt-proBNP may thus serve as a screening instrument to select patients with type 2 diabetes who could benefit from an echocardiographical examination.

Abbreviations: ALVD, asymptomatic left ventricular dysfunction • BNP, brain natriuretic peptide • LVD, left ventricular dysfunction • Nt-proBNP, NH₂-terminal portion of the precursor of BNP • SBP, systolic blood pressure

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