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Original Research

The Midregional Fragment of Pro-A–Type Natriuretic Peptide, Blood Pressure, and Mortality in a Prospective Cohort Study of Patients With Type 2 Diabetes (ZODIAC-25)

  1. Kornelis J.J. van Hateren, MD1⇑,
  2. Gijs W.D. Landman, MD1,
  3. Nanne Kleefstra, MD, PHD1,2,3,
  4. Klaas H. Groenier, PHD4,
  5. Joachim Struck, PHD5,
  6. Gerjan J. Navis, MD, PHD3,
  7. Stephan J.L. Bakker, MD, PHD3,
  8. Sebastiaan T. Houweling, MD, PHD2,4,
  9. Klaas van der Meer, MD, PHD4 and
  10. Henk J.G. Bilo, MD, PHD, FRCP1,3,6
  1. 1Diabetes Centre, Isala Clinics, Zwolle, the Netherlands
  2. 2Langerhans Medical Research Group, Zwolle, the Netherlands
  3. 3Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
  4. 4Department of General Practice, University Medical Center Groningen, Groningen, the Netherlands
  5. 5Research Department, B.R.A.H.M.S. GmbH (Thermo Fisher Scientific), Hennigsdorf/Berlin, Germany
  6. 6Department of Internal Medicine, Isala Clinics, Zwolle, the Netherlands.
  1. Corresponding author: Kornelis J.J. van Hateren, k.j.j.van.hateren{at}isala.nl
Diabetes Care 2013 May; 36(5): 1347-1352. https://doi.org/10.2337/dc12-0428
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Abstract

OBJECTIVE Evidence that midregional fragment of pro-A–type natriuretic peptide (MR-proANP) is a marker of mortality in patients with type 2 diabetes is limited. Therefore, we aimed to investigate the capabilities of MR-proANP in predicting mortality. We also investigated whether MR-proANP influences the relationship between blood pressure and mortality in old age.

RESEARCH DESIGN AND METHODS In 1998, 1,143 primary care patients with type 2 diabetes participated in the ZODIAC study. Because blood was drawn for 867 patients (76%) and confounders were missing for 19 patients, the final study sample comprised 848 patients. After a follow-up time of 10 years, we used Cox proportional hazard models to evaluate the relationship between MR-proANP and (cardiovascular) mortality. Harrell C statistic was used to compare models with and without MR-proANP. The regression analyses were repeated without MR-proANP for patients aged older than 75 years.

RESULTS Median MR-proANP in the total study sample was 75 pmol/L (interquartile range, 48–124 pmol/L). During follow-up, 354 (42%) out of 848 patients had died, of whom 152 (43%) deaths were attributable to cardiovascular factors. MR-proANP was independently associated with all-cause and cardiovascular mortality, irrespective of age. During old age, there was a significant inverse relationship between blood pressure and mortality. This relationship did not change after adjustment for MR-proANP.

CONCLUSIONS MR-proANP is independently associated with mortality in patients with type 2 diabetes. MR-proANP did not influence the inverse relationship between blood pressure and mortality in elderly patients.

  • Received March 3, 2012.
  • Accepted October 23, 2012.
  • © 2013 by the American Diabetes Association.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

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The Midregional Fragment of Pro-A–Type Natriuretic Peptide, Blood Pressure, and Mortality in a Prospective Cohort Study of Patients With Type 2 Diabetes (ZODIAC-25)
Kornelis J.J. van Hateren, Gijs W.D. Landman, Nanne Kleefstra, Klaas H. Groenier, Joachim Struck, Gerjan J. Navis, Stephan J.L. Bakker, Sebastiaan T. Houweling, Klaas van der Meer, Henk J.G. Bilo
Diabetes Care May 2013, 36 (5) 1347-1352; DOI: 10.2337/dc12-0428

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The Midregional Fragment of Pro-A–Type Natriuretic Peptide, Blood Pressure, and Mortality in a Prospective Cohort Study of Patients With Type 2 Diabetes (ZODIAC-25)
Kornelis J.J. van Hateren, Gijs W.D. Landman, Nanne Kleefstra, Klaas H. Groenier, Joachim Struck, Gerjan J. Navis, Stephan J.L. Bakker, Sebastiaan T. Houweling, Klaas van der Meer, Henk J.G. Bilo
Diabetes Care May 2013, 36 (5) 1347-1352; DOI: 10.2337/dc12-0428
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© 2021 by the American Diabetes Association. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548.