Screening Natriuretic Peptide Levels Predict Heart Failure and Mortality in Individuals with Type 1 and Type 2 Diabetes without Known Heart Failure

<p dir="ltr">Objective: Heart failure (HF) is common in diabetes and may be asymptomatic in early stages. NT-proBNP and BNP [collectively natriuretic peptides (NP)] detect early HF in asymptomatic individuals who may benefit from disease-modifying therapies. We examined the prognostic role of NP levels in people with type 1 diabetes (T1D) or type 2 diabetes (T2D) without known HF.</p><p dir="ltr">Research Design and Methods: Optum’s de-identified Market Clarity Data was queried for adults (≥18 years) with T1D or T2D without known HF who received an outpatient NP test between 2017–2023. Associations between NP levels and incident HF or death were assessed using multivariable Cox proportional hazard models. </p><p dir="ltr">Results: Among 116,466 eligible adults (2,990 T1D; 113,476 T2D) followed for up to 7 years (54% female, median age 64, mean HbA1c 7.1% at baseline), roughly 39.6% of individuals with T1D and 42.3% of individuals with T2D had BNP≥50 or NT-proBNP≥125. In adjusted Cox models, increased NT-proBNP was significantly associated with increased risk of incident HF or mortality among individuals with T1D (HR [95% CI] NT-proBNP 125-300: 2.04 [1.35-3.07]; NT-proBNP>300: 4.48 [3.11-6.47], ref: NT-proBNP<125) and T2D (HR [95% CI] NT-proBNP 125-300: 1.85 [1.74-1.97]; NT-proBNP>300: 3.58 [3.39-3.78], ref: NT-proBNP<125). Similar findings were observed for BNP.</p><p dir="ltr">Conclusions: Increased NP levels among individuals with diabetes are highly prognostic for future risk of HF or mortality. These findings support the implementation of NP screening for HF risk assessment in people with diabetes.</p>