Additive prognostic value of plasma N-terminal pro-brain natriuretic peptide and coronary artery calcification for cardiovascular events and mortality in asymptomatic patients with type 2 diabetes

Bernt Johan von Scholten; Henrik Reinhard; Tine Willum Hansen; Morten Lindhardt; Claus Leth Petersen; Niels Wiinberg; Peter Riis Hansen; Hans-Henrik Parving; Peter Karl Jacobsen; Peter Rossing

doi:10.1186/s12933-015-0225-0

Additive prognostic value of plasma N-terminal pro-brain natriuretic peptide and coronary artery calcification for cardiovascular events and mortality in asymptomatic patients with type 2 diabetes

Bernt Johan von Scholten, Henrik Reinhard, Tine Willum Hansen, Morten Lindhardt, Claus Leth Petersen, Niels Wiinberg, Peter Riis Hansen, Hans-Henrik Parving, Peter Karl Jacobsen, Peter Rossing

25 Citationer (Scopus)

Abstract

Background In patients with type 2 diabetes, cardiovascular disease (CVD) is the major cause of morbidity and mortality. We evaluated the combination of NT-proBNP and coronary artery calcium score (CAC) for prediction of combined fatal and non-fatal CVD and mortality in patients with type 2 diabetes and microalbuminuria (>30 mg/24-h), but without known coronary artery disease. Moreover, we assessed the predictive value of a predefined categorisation of patients into a high- and low-risk group at baseline. Methods Prospective study including 200 patients. All received intensive multifactorial treatment. Patients with baseline NT-proBNP >45.2 ng/L and/or CAC ≥400 were stratified as high-risk patients (n = 133). Occurrence of fatal- and nonfatal CVD (n = 40) and mortality (n = 26), was traced after 6.1 years (median). Results High-risk patients had a higher risk of the composite CVD endpoint (adjusted hazard ratio [HR] 10.6 (95 % confidence interval [CI] 2.4-46.3); p = 0.002) and mortality (adjusted HR 5.3 (95 % CI 1.2-24.0); p = 0.032) compared to low-risk patients. In adjusted continuous analysis, both higher NT-proBNP and CAC were strong predictors of the composite CVD endpoint and mortality (p ≤ 0.0001). In fully adjusted models mutually including NT-proBNP and CAC, both risk factors remained associated with risk of CVD and mortality (p ≤ 0.022). There was no interaction between NT-proBNP and CAC for the examined endpoints (p ≥ 0.31). Conclusions In patients with type 2 diabetes and microalbuminuria but without known coronary artery disease, NT-proBNP and CAC were strongly associated with fatal and nonfatal CVD, as well as with mortality. Their additive prognostic capability holds promise for identification of patients at high risk.

Originalsprog	Engelsk
Artikelnummer	59
Tidsskrift	Cardiovascular Diabetology
Vol/bind	14
Udgave nummer	10
Sider (fra-til)	1-10
Antal sider	10
ISSN	1475-2840
DOI	https://doi.org/10.1186/s12933-015-0225-0
Status	Udgivet - 21 maj 2015

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10.1186/s12933-015-0225-0Licens: CC BY

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von Scholten, B. J., Reinhard, H., Hansen, T. W., Lindhardt, M., Petersen, C. L., Wiinberg, N., Hansen, P. R., Parving, H-H., Jacobsen, P. K., & Rossing, P. (2015). Additive prognostic value of plasma N-terminal pro-brain natriuretic peptide and coronary artery calcification for cardiovascular events and mortality in asymptomatic patients with type 2 diabetes. Cardiovascular Diabetology, 14(10), 1-10. [59]. https://doi.org/10.1186/s12933-015-0225-0

Additive prognostic value of plasma N-terminal pro-brain natriuretic peptide and coronary artery calcification for cardiovascular events and mortality in asymptomatic patients with type 2 diabetes. / von Scholten, Bernt Johan; Reinhard, Henrik; Hansen, Tine Willum et al.

I: Cardiovascular Diabetology, Bind 14, Nr. 10, 59, 21.05.2015, s. 1-10.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

von Scholten, BJ, Reinhard, H, Hansen, TW, Lindhardt, M, Petersen, CL, Wiinberg, N, Hansen, PR, Parving, H-H, Jacobsen, PK & Rossing, P 2015, 'Additive prognostic value of plasma N-terminal pro-brain natriuretic peptide and coronary artery calcification for cardiovascular events and mortality in asymptomatic patients with type 2 diabetes', Cardiovascular Diabetology, bind 14, nr. 10, 59, s. 1-10. https://doi.org/10.1186/s12933-015-0225-0

@article{c7cc043c24a04ae2a3fac044bd4e6d88,

title = "Additive prognostic value of plasma N-terminal pro-brain natriuretic peptide and coronary artery calcification for cardiovascular events and mortality in asymptomatic patients with type 2 diabetes",

abstract = "Background: In patients with type 2 diabetes, cardiovascular disease (CVD) is the major cause of morbidity and mortality. We evaluated the combination of NT-proBNP and coronary artery calcium score (CAC) for prediction of combined fatal and non-fatal CVD and mortality in patients with type 2 diabetes and microalbuminuria (>30 mg/24-h), but without known coronary artery disease. Moreover, we assessed the predictive value of a predefined categorisation of patients into a high- and low-risk group at baseline. Methods: Prospective study including 200 patients. All received intensive multifactorial treatment. Patients with baseline NT-proBNP >45.2 ng/L and/or CAC ≥400 were stratified as high-risk patients (n = 133). Occurrence of fatal- and nonfatal CVD (n = 40) and mortality (n = 26), was traced after 6.1 years (median). Results: High-risk patients had a higher risk of the composite CVD endpoint (adjusted hazard ratio [HR] 10.6 (95 % confidence interval [CI] 2.4-46.3); p = 0.002) and mortality (adjusted HR 5.3 (95 % CI 1.2-24.0); p = 0.032) compared to low-risk patients. In adjusted continuous analysis, both higher NT-proBNP and CAC were strong predictors of the composite CVD endpoint and mortality (p ≤ 0.0001). In fully adjusted models mutually including NT-proBNP and CAC, both risk factors remained associated with risk of CVD and mortality (p ≤ 0.022). There was no interaction between NT-proBNP and CAC for the examined endpoints (p ≥ 0.31). Conclusions: In patients with type 2 diabetes and microalbuminuria but without known coronary artery disease, NT-proBNP and CAC were strongly associated with fatal and nonfatal CVD, as well as with mortality. Their additive prognostic capability holds promise for identification of patients at high risk.",

keywords = "Aged, Albuminuria, Asymptomatic Diseases, Biomarkers, Cardiovascular Diseases, Cohort Studies, Coronary Artery Disease, Diabetes Mellitus, Type 2, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Multidetector Computed Tomography, Natriuretic Peptide, Brain, Peptide Fragments, Prognosis, Proportional Hazards Models, Prospective Studies, Vascular Calcification",

author = "{von Scholten}, {Bernt Johan} and Henrik Reinhard and Hansen, {Tine Willum} and Morten Lindhardt and Petersen, {Claus Leth} and Niels Wiinberg and Hansen, {Peter Riis} and Hans-Henrik Parving and Jacobsen, {Peter Karl} and Peter Rossing",

year = "2015",

month = may,

day = "21",

doi = "10.1186/s12933-015-0225-0",

language = "English",

volume = "14",

pages = "1--10",

journal = "Cardiovascular Diabetology",

issn = "1475-2840",

publisher = "BioMed Central Ltd.",

number = "10",

}

TY - JOUR

T1 - Additive prognostic value of plasma N-terminal pro-brain natriuretic peptide and coronary artery calcification for cardiovascular events and mortality in asymptomatic patients with type 2 diabetes

AU - von Scholten, Bernt Johan

AU - Reinhard, Henrik

AU - Hansen, Tine Willum

AU - Lindhardt, Morten

AU - Petersen, Claus Leth

AU - Wiinberg, Niels

AU - Hansen, Peter Riis

AU - Parving, Hans-Henrik

AU - Jacobsen, Peter Karl

AU - Rossing, Peter

PY - 2015/5/21

Y1 - 2015/5/21

N2 - Background: In patients with type 2 diabetes, cardiovascular disease (CVD) is the major cause of morbidity and mortality. We evaluated the combination of NT-proBNP and coronary artery calcium score (CAC) for prediction of combined fatal and non-fatal CVD and mortality in patients with type 2 diabetes and microalbuminuria (>30 mg/24-h), but without known coronary artery disease. Moreover, we assessed the predictive value of a predefined categorisation of patients into a high- and low-risk group at baseline. Methods: Prospective study including 200 patients. All received intensive multifactorial treatment. Patients with baseline NT-proBNP >45.2 ng/L and/or CAC ≥400 were stratified as high-risk patients (n = 133). Occurrence of fatal- and nonfatal CVD (n = 40) and mortality (n = 26), was traced after 6.1 years (median). Results: High-risk patients had a higher risk of the composite CVD endpoint (adjusted hazard ratio [HR] 10.6 (95 % confidence interval [CI] 2.4-46.3); p = 0.002) and mortality (adjusted HR 5.3 (95 % CI 1.2-24.0); p = 0.032) compared to low-risk patients. In adjusted continuous analysis, both higher NT-proBNP and CAC were strong predictors of the composite CVD endpoint and mortality (p ≤ 0.0001). In fully adjusted models mutually including NT-proBNP and CAC, both risk factors remained associated with risk of CVD and mortality (p ≤ 0.022). There was no interaction between NT-proBNP and CAC for the examined endpoints (p ≥ 0.31). Conclusions: In patients with type 2 diabetes and microalbuminuria but without known coronary artery disease, NT-proBNP and CAC were strongly associated with fatal and nonfatal CVD, as well as with mortality. Their additive prognostic capability holds promise for identification of patients at high risk.

AB - Background: In patients with type 2 diabetes, cardiovascular disease (CVD) is the major cause of morbidity and mortality. We evaluated the combination of NT-proBNP and coronary artery calcium score (CAC) for prediction of combined fatal and non-fatal CVD and mortality in patients with type 2 diabetes and microalbuminuria (>30 mg/24-h), but without known coronary artery disease. Moreover, we assessed the predictive value of a predefined categorisation of patients into a high- and low-risk group at baseline. Methods: Prospective study including 200 patients. All received intensive multifactorial treatment. Patients with baseline NT-proBNP >45.2 ng/L and/or CAC ≥400 were stratified as high-risk patients (n = 133). Occurrence of fatal- and nonfatal CVD (n = 40) and mortality (n = 26), was traced after 6.1 years (median). Results: High-risk patients had a higher risk of the composite CVD endpoint (adjusted hazard ratio [HR] 10.6 (95 % confidence interval [CI] 2.4-46.3); p = 0.002) and mortality (adjusted HR 5.3 (95 % CI 1.2-24.0); p = 0.032) compared to low-risk patients. In adjusted continuous analysis, both higher NT-proBNP and CAC were strong predictors of the composite CVD endpoint and mortality (p ≤ 0.0001). In fully adjusted models mutually including NT-proBNP and CAC, both risk factors remained associated with risk of CVD and mortality (p ≤ 0.022). There was no interaction between NT-proBNP and CAC for the examined endpoints (p ≥ 0.31). Conclusions: In patients with type 2 diabetes and microalbuminuria but without known coronary artery disease, NT-proBNP and CAC were strongly associated with fatal and nonfatal CVD, as well as with mortality. Their additive prognostic capability holds promise for identification of patients at high risk.

KW - Aged

KW - Albuminuria

KW - Asymptomatic Diseases

KW - Biomarkers

KW - Cardiovascular Diseases

KW - Cohort Studies

KW - Coronary Artery Disease

KW - Diabetes Mellitus, Type 2

KW - Female

KW - Humans

KW - Kaplan-Meier Estimate

KW - Male

KW - Middle Aged

KW - Multidetector Computed Tomography

KW - Natriuretic Peptide, Brain

KW - Peptide Fragments

KW - Prognosis

KW - Proportional Hazards Models

KW - Prospective Studies

KW - Vascular Calcification

U2 - 10.1186/s12933-015-0225-0

DO - 10.1186/s12933-015-0225-0

M3 - Journal article

C2 - 25990319

SN - 1475-2840

VL - 14

SP - 1

EP - 10

JO - Cardiovascular Diabetology

JF - Cardiovascular Diabetology

IS - 10

M1 - 59

ER -

Additive prognostic value of plasma N-terminal pro-brain natriuretic peptide and coronary artery calcification for cardiovascular events and mortality in asymptomatic patients with type 2 diabetes

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