N-terminal pro-brain natriuretic peptide and risk of cardiovascular events in older patients with type 2 diabetes: the Edinburgh Type 2 Diabetes Study |
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Authors: | Anna H. Price Paul Welsh Christopher J. Weir Insa Feinkohl Christine M. Robertson Joanne R. Morling Stela McLachlan Mark W. J. Strachan Naveed Sattar Jackie F. Price |
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Affiliation: | 1. Centre for Population Health Sciences, The University of Edinburgh Medical School, Teviot Place, Edinburgh, Scotland, EH8 9AG, UK 2. Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK 3. Edinburgh Health Services Research Unit, Edinburgh, UK 4. Metabolic Unit, Western General Hospital, Edinburgh, UK
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Abstract: | Aims/hypothesis The aim of this study was to investigate the association of N-terminal pro-brain natriuretic peptide (NT-proBNP) with traditional cardiovascular risk factors and incident cardiovascular events in older people with type 2 diabetes. Methods In the prospective phase of the Edinburgh Type 2 Diabetes Study, 1066 men and women aged 60 to 75 years with type 2 diabetes mellitus were followed for 4 years; 112 participants had an incident cardiovascular event. At baseline, cardiovascular risk factors, pre-existing cardiovascular disease and levels of NT-proBNP were evaluated. Results Raised plasma NT-proBNP levels were associated with these classical cardiovascular risk factors: increased duration of diabetes, use of insulin, raised BMI, reduced HDL-cholesterol, reduced renal function and use of lipid-lowering and anti-hypertensive medication (all p?0.05). In the prospective analysis, NT-proBNP was strongly associated with subsequent risk of all cardiovascular disease events (HR per one SD increase in NT-proBNP 1.39; 95% CI 1.10, 1.75), independent of cardiovascular risk factors traditionally used to predict vascular events. NT-proBNP was also independently associated with incident coronary artery disease events (1.48, 95% CI 1.10, 1.98). The addition of NT-proBNP to multivariate models improved the C-index by 0.019 for the ‘hard’ cardiac endpoint (fatal and non-fatal myocardial infarction). Conclusions/interpretation In older people with type 2 diabetes, NT-proBNP is associated with the development of coronary and cerebrovascular events, independent of a wide range of other vascular and metabolic risk factors, and may prove a useful addition to current vascular risk scores in diabetes populations. |
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