NT–proBNP has additive predictive value for heart failure in diabetic patients
Cardiac Stress and Inflammatory Markers as Predictors of Heart Failure in Patients With Type 2 Diabetes: The ADVANCE TrialLiterature - Ohkuma T, Jun M, Woodward M, et al; ADVANCE Collaborative Group. - Diabetes Care. 2017; published online ahead of print
- During a median follow-up of 5 years, 237 patients who experienced an HF event had significantly higher levels of IL-6, hs-CRP, hs-cTnT and NT-proBNP.
- HF risk increased significantly with increasing levels of all biomarkers after adjustment for age, gender, randomized blood pressure–lowering, glucose-control interventions and clinical risk factors (all P for trend <0.01).
- The multivariable-adjusted HRs for HF according to the highest fifths compared with the lowest fifths of each biomarker were 2.62 for IL-6 (95% CI: 1.48–4.63), 2.22 for hs-CRP (95% CI: 1.33–3.72), 2.70 for hs-cTnT (95% CI: 1.68–4.34), 12.53 for NT-proBNP (95% CI: 5.41–29.02).
- Higher values of all four biomarkers were significantly associated with a higher risk of HF after adjusting for clinical risk factors (all P<0.001).
- After further adjustment for the other studied biomarkers, the associations were attenuated and became non-significant for hs-CRP and hs-cTnT.
- NT-proBNP showed the strongest association with HF (HR 2.77, 95% CI 2.12–3.63).
- Significant heterogeneity (P=0.004) was observed in the association of patients with (HR 2.28, 95% CI 1.08–4.81) and without (HR 3.52, 95% CI 2.66–4.66) a history of myocardial infarction.
- The addition of NT-proBNP to a model including conventional risk factors greatly improved discrimination and classification of the 5-year HF risk (C statistic: 0.8162-0.8800; P<0.001, integrated discrimination index [IDI] 0.107, P<0.001, continuous net reclassification improvement [NRI] 0.731, P<0.001, categorical NRI 0.242, P<0.001).
- The improvements were not uniformly significant when adding IL-6, hs-CRP or hs-cTnT to the above model.
In T2DM patients at high cardiovascular risk, markers IL-6, hs-CRP, hs-cTnT and NT-proBNP were independent predictors of the incidence of HF, but only the addition of NT-proBNP improved the predictive performance for HF on top of conventional clinical risk factors.