• Prevention & Screening
• Diabetes & Endocrinology Clinical Trials
• Heart FailureDiabetes Mellitus

Individuals with type 2 diabetes mellitus (T2DM) have an increased risk of developing heart failure (HF) and a worse prognosis if they already have HF. B-type natriuretic peptide (BNP) is a marker for HF—patients with nonsystolic HF have significantly (p<0.001) lower BNP levels than those with systolic HF [Maisel J et al. J Am Coll Cardiol 2003].

BNP levels that are well below current thresholds that are used to diagnose HF (<100 pg/mL) have been associated with increases in left ventricular (LV) mass and deterioration of LV systolic and diastolic function and can predict HF and cardiovascular disease (CVD) mortality [Wang TJ et al. N Eng J Med 2004]. BNP's association with LV mass and markers of LV diastolic function appears to be particularly strong in individuals with T2DM [Van den Hurk K et al. Eur J Heart Fail 2010].

Marieke H. Kroon, VU Medical Center, Amsterdam, The Netherlands, reviewed data from the Hoorn Study, which prospectively investigated whether BNP levels in a nonheart failure range predict LV mass, or LV systolic and diastolic function in individuals with and without T2DM.

Participants with atrial fibrillation, wall movement abnormalities, and moderate or severe aortic or mitral valve disease were excluded from this study. Plasma BNP (pmol/L) levels were measured, and 2D echocardiograms were performed at baseline (2000–2001). Follow-up was 8 years later. The 2D echocardiograms were used to measure LV mass index (LVMI, g/m²), ejection fraction (% EF, systolic function), and left atrial volume index (LAVI, mL/m², diastolic function). Linear regression analyses, adjusted for gender, age, baseline heart function, use of antihypertensive medication, body mass index (BMI), and heart rate (HR), were performed to investigate the association of BNP with LVMI and of LV systolic with diastolic function. In case of significant effect modification (p<0.10), the linear regression coefficients for individuals with and without T2DM were reported separately.

Of the 796 participants who had baseline echocardiograms (baseline age 66 years; 32% with T2DM), 301 were available for the follow-up examination. Blood pressure levels were lower in T2DM patients at baseline. LV systolic function (% EF) and BNP were not significantly associated with either T2DM or non-T2DM patients when adjusted for age, gender, baseline EF, use of antihypertensives, BMI, and HR. However, this association was significant (p<0.05) when the total population was considered (Table 1). LV diastolic function (LAVI) and BNP levels were significantly (p<0.05) associated with T2DM and non-T2DM patients. LV mass (LVMI) and BNP level were significantly (p<0.05) associated in T2DM but not non-T2DM patients. The increase in LVMI was greater among those with higher baseline BNP, and the association was stronger among patients with T2DM. In patients without T2DM, the association was explained by baseline LVMI, BMI, and use of antihypertensives; in the T2DM patients, the association was independent. Regardless of T2DM status, a 10-pmol/L higher baseline BNP was associated with a 2.7% lower EF and a 5.0-mL/m² higher LAVI at follow-up.

These results suggest that slightly elevated BNP levels are associated with changes in LV systolic and diastolic function. This association was not dependent on T2DM status. Only in T2DM patients were higher BNP levels associated with increase in LV mass. Thus, the presence or absence of T2DM should be taken into account if BNP levels are used to assess CVD risk.

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