Physicians' Academy for Cardiovascular Education

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 Trial

Literature - Ohkuma T, Jun M, Woodward M, et al; ADVANCE Collaborative Group. - Diabetes Care. 2017; published online ahead of print


Diabetes increases the risk of heart failure (HF) by more than 50% and has a negative impact on HF prognosis [1,2]. Thus, the prevention and treatment of HF in diabetic patients as well as their HF risk stratification are important, however there are limited data regarding the use of cardiovascular disease-related biomarkers in this setting [3].

In this study, the association of the markers NT-proBNP, hs-cTnT, hs-CRP and IL-6 with risk of HF was evaluated in type 2 diabetes mellitus (T2DM) patients. Moreover, the additional risk-predictive ability of these markers was assessed, on top of traditional clinical risk factors. For this purpose, a nested case-cohort study was conducted including patients from the ADVANCE study, in which 11,140 T2DM patients at high cardiovascular risk were randomized to an intensive gliclazide modified release-based glucose control regimen or standard guidelines-based therapy and after a 6-week run-in period, to perindopril-indapamide or matching placebo [4-6]. In the end, 3,098 patients were included in the analysis. The study outcome was the incidence or progression of HF (death due to HF, HF hospitalization or worsening of NYHA classification).

Main results


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.


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