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

  1. Martin Magnusson, MD1,
  2. Olle Melander, MD, PHD2,
  3. Bo Israelsson, MD, PHD1,
  4. Anders Grubb, MD, PHD3,
  5. Leif Groop, MD, PHD2 and
  6. Stefan Jovinge, MD, PHD145
  1. 1Department of Cardiology, University Hospital MAS, Lund University, Sweden
  2. 2Department of Endocrinology, University Hospital MAS, Lund University, Lund, Sweden
  3. 3Department of Clinical Chemistry, University Hospital in Lund, Lund University, Lund, Sweden
  4. 4Cardiovascular Research Group, Wallenberg Laboratory University Hospital MAS, Lund University, Lund, Sweden
  5. 5Lund Strategic Research Center for Stem Cell Biology and Cell Therapy, Lund, Sweden
  1. 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

Abstract

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.

Footnotes

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted March 25, 2004.
    • Received December 1, 2003.
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  1. doi: 10.2337/diacare.27.8.1929 Diabetes Care August 2004 vol. 27 no. 8 1929-1935
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