Natriuretic peptide levels predicted heart failure risk in diabetes
A test manufacturer's retrospective analysis of type 1 and 2 diabetes patients who underwent natriuretic peptide testing found that elevated levels of terminal pro-brain natriuretic peptide or B-type natriuretic peptide were associated with development of heart failure and death.
Elevated natriuretic peptide levels among patients with diabetes are highly prognostic of risk of heart failure (HF) or mortality, an industry-funded study found.
Researchers examined the prognostic role of N-terminal pro-brain natriuretic peptide (NT-proBNP) and B-type natriuretic peptide (BNP) levels using a commercial database to identify adult patients with type 1 or 2 diabetes but no known HF who received an outpatient NT-proBNP or BNP test in 2017 to 2023. This study was funded by Roche Diagnostics Corp. Results were published Oct. 30 by Diabetes Care.
Among 116,466 study patients (2,990 with type 1 diabetes, 13,476 with type 2) followed for up to seven years (54% female; median age, 64 years; mean HbA1c, 7.1% at baseline), elevated test results were common. Overall, 39.6% of patients with type 1 diabetes and 42.3% of those with type 2 had either a BNP level of 50 pg/mL or greater or an NT-proBNP level of 125 pg/mL or greater.
Elevations in NT-proBNP level were significantly associated with risk of incident HF or mortality among patients with type 1 diabetes: Compared to a reference level of less than 125 pg/mL, the hazard ratio (HR) with a NT-proBNP level of 125 to 300 pg/mL was 2.04 (95% CI, 1.35 to 3.07), and for a level above 300 pg/mL, it was 4.48 (95% CI, 3.11 to 6.47). For type 2 diabetes patients, the HRs were 1.85 (95% CI, 1.74–1.97) and 3.58 (95% CI, 3.39 to 3.78), respectively. The associations with BNP elevations were similar.
The findings support the implementation of natriuretic peptide screening for HF risk assessment in patients with diabetes, according to the study authors. A novel contribution of this study was its demonstration of the prognostic value of testing specifically among patients with type 1 diabetes, they added.
Limitations of the study include that it was observational and thus the indications for testing were unknown, potentially creating selection bias regarding which patients received testing. The authors suggested future prospective studies could provide stronger evidence.
“Early identification of elevated NP levels could enable targeted preventive interventions, particularly in higher-risk individuals who might derive the greatest benefit from preventive therapies,” the researchers concluded.