American Diabetes Association
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Opposing associations of NT-proBNP with risks of diabetes and diabetes-related complications

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posted on 2020-08-17, 19:14 authored by Anna Birukov, Fabian Eichelmann, Olga Kuxhaus, Elli Polemiti, Andreas Fritsche, Janine Wirth, Heiner Boeing, Cornelia Weikert, Matthias B. Schulze
Objective: Circulating N-terminal pro b-type natriuretic peptide (NT-proBNP) is a classic diagnostic and prognostic marker for heart failure. However, it is inversely associated with diabetes risk. We aimed to investigate relationships of NT-proBNP with risk of diabetes-related complications in initially healthy individuals.

Research Design and Methods: We performed a case-cohort study within the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam cohort including a random subcohort (n=1294) and incident cases of type 2 diabetes (n=649) and cardiovascular diseases (CVD, n=478). Incident cases of type 2 diabetes (n=545) were followed up for micro- (n=133) and macrovascular (n=50) complications. Plasma NT-proBNP was measured at baseline in initially healthy participants.

Results: In multivariable models, NT-proBNP was linearly inversely associated with incident type 2 diabetes, HR (95% CI) per doubling in NT-proBNP: 0.91 (0.86; 0.98). The association was only observable in women, HR (95%CI): 0.80 (0.72; 0.90), compared to 0.98 (0.91; 1.07) in men. Among persons with incident diabetes, NT-proBNP was positively associated with diabetes complications, HR (95% CI): 1.31 (1.13; 1.53) for overall, 1.20 (1.01; 1.43) for micro- and 1.37 (1.03; 1.83) for macrovascular complications.

Conclusions: Although higher NT-proBNP levels are associated with lower diabetes risk, in persons who develop diabetes NT-proBNP is a biomarker for vascular complications independent of potential confounders. Thus, NT-proBNP might be informative to monitor risk for diabetes-related micro- and macrovascular complications, which should be further explored in future prospective studies.


The recruitment phase of the EPIC-Potsdam Study was supported by the Federal Ministry of Science, Germany (01 EA 9401) and the European Union (SOC 95201408 05F02). The follow-up of the EPIC-Potsdam Study was supported by German Cancer Aid (70-2488-Ha I) and the European Community (SOC 98200769 05F02). This work was furthermore supported by a grant from the German Ministry of Education and Research (BMBF) and the State of Brandenburg (DZD grant 82DZD00302).


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