NH2-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
- Graziella Bruno, MD1⇑,
- Andrea Landi, MD1,
- Federica Barutta, PHD1,
- Giuseppe Ghezzo, MD2,
- Claudio Baldin, BSC2,
- Laura Spadafora, MD1,
- Andrea Schimmenti, MD1,
- Tania Prinzis, MD1,
- Paolo Cavallo Perin, MD1 and
- Gabriella Gruden, PHD1
- 1Department of Medical Sciences, University of Turin, Turin, Italy
- 2Santo Spirito Hospital, Casale Monferrato, Alessandria, Italy
- Corresponding author: Graziella Bruno, .
OBJECTIVE To study whether NH2-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.
RESEARCH DESIGN AND METHODS 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).
RESULTS 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.
CONCLUSIONS 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.
- Received February 11, 2013.
- Accepted March 12, 2013.
- © 2013 by the American Diabetes Association.
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