The value of NT-proBNP in cardiovascular risk assessment of patients with type 2 diabetes

Clinician with patient

Cardiovascular disease in patients with type 2 diabetes

Family

Up to one in seven patients with type 2 diabetes (T2D) will develop heart failure in their lifetime.1

Symptom

Co-existence of T2D and heart failure is associated with worse symptoms and quality of life, increased hospitalisations and higher mortality rates compared to patients without T2D.3

Heart

Heart failure is one of the earliest, most common and serious cardiovascular complications in patients with T2D.2

Hospital

Even when all cardiovascular risk factors including blood pressure, smoking, cholesterol, triglycerides and blood glucose were optimally controlled, people with T2D still had a 21% higher risk for CVD and 31% higher risk for heart failure hospitalisation than people without T2D.4

There is a need to further individualise risk beyond the presence of accepted clinical risk factors.5

NT-proBNP may be the earliest sign to detect heart failure in people with T2D before structural and functional changes become apparent on imaging6,7

NT-proBNP may be the earliest sign to detect heart failure in people with T2D before structural and functional changes become apparent on imaging

Figure 1: Diagramatic representation of the concept of biomarkers in detecting early stage heart failure. Adapted from Gallagher et al. 2017

Patients with T2D and an elevated NT-proBNP are at higher risk of unplanned CV hospitalisation or death within the next 12 months8

Patients with T2D and an elevated NT-proBNP are at higher risk of unplanned CV hospitalisation or death within the next 12 months

NT-proBNP is a stronger predictor of CV related event of death for patients with T2D over HbA1c and albuminuria9,10

NT-proBNP is a stronger predictor of CV related event of death for T2D patients over HbA1c and albuminuria

NT-proBNP may help identify people with T2D at risk of heart failure hospitalisation (HFH) six months before the cardiac event, regardless of the history of heart failure11

Elevated NT-proBNP level strongly predicts HF events in T2DM patients

International recognition of the prognostic value of NT-proBNP in patients with T2D12

2022 AHA/ACC/HFSA Guideline

'For patients at risk of developing HF, natriuretic peptide biomarker-based screening followed by team-based care, including a cardiovascular specialist optimising GDMT, can be useful to prevent the development of LV dysfunction or new-onset HF.'12

 

ESC position paper 2016

NP measurement by general practitioners and diabetologists in high-risk populations such as those with hypertension or diabetes mellitus helps the targeted initiation of preventive measures, including medicine up-titration of renin–angiotensin system antagonists and, therefore, prevent or slow the development of HF.13

 

Consensus document by the HFA of the ESC

'Screening might be considered in patients with conditions predisposing to HF, such as hypertension and diabetes, to identify subclinical HF that warrants initiation of cardiac protective therapies. A possible alternative to the current approach to HF screening in hypertensive and diabetic individuals is a two-step screening with the measurement of NPs or hs-troponin and then transthoracic echocardiogram (TTE), when circulating biomarkers are either elevated or rising.'14

If you're interested in understanding more about how NT-proBNP can be used to support CVD risk assessment in patients with type 2 diabetes please contact us.
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Abbreviations

AHA/ACC/HFSA: American Heart Association/American College of Cardiology/Heart Failure Society of America;  CI: Confidence interval; CV: Cardiovascular; CVD: Cardiovascular disease; DM: Diabetes mellitus; ESC: European College of Cardiology; HbA1c: Hemoglobin A1c; HF: Heart failure; HFA: Heart Failure Association; HFH: Heart failure hospitalisation; N.S.: Not significant;  NP: Natriuretic Peptide, NT-proBNP: N terminal pro B type natriuretic peptide; TTE: Transthoracic echocardiogram; T2DM: Type 2 diabetes mellitus

 

References

  1. Shah et al. (2015) Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1·9 million people. Lancet Diabetes Endocrinol 2015; 3: 105–13
  2. Birkeland et al. (2020) Diabetes Obes Metab. 22: 1607– 1618. https://doi.org/10.1111/dom.14074 
  3. Seferović et al. (2020), Eur J Heart Fail, 22: 196-213. https://doi.org/10.1002/ejhf.1673
  4. Wright et al. 2020. Risk Factor Control and Cardiovascular Event Risk in People With Type 2 Diabetes in Primary and Secondary Prevention Settings. Circulation Volume 142, Issue 20, 17 November 2020; Pages 1925-1936. https://doi.org/10.1161/CIRCULATIONAHA.120.046783
  5. Mueller et al. 2019. Eur J Heart Fail. 2019 Jun;21(6):715-731. doi: 10.1002/ejhf.1494. PMID: 31222929.
  6. Magnusson M et al. Diabetes Care. 2004;27:1929-35; 
  7. Gallagher J et al. Cardiac Failure Review. 2017;3:83–85.
  8. Huelsmann M, et al. Eur Heart J. 2008;29(18):2259-2264. doi:10.1093/eurheartj/ehn334.
  9. Neuhold S, et al. Eur J Clin Invest. 2011;41:1292-1298. 
  10. Clodi M, et al. Eur. J. Prev. Cardiol. 2011;19:944-951. 
  11. Wolsk E, et al. Circulation. 2017;136:1560-1562. doi:10.1161/CIRCULATIONAHA.117.029503.
  12. Heidenreich PA, et al. 2022 AHA/ACC/HFSA Guideline for the management of heart failure: A report of the American College of  Cardiology/American Heart Association/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation.  2022145:e895-e1032.
  13. Ponikowski P, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2016; 18: 891–975.
  14. Moura B, et al. European Journal of Heart Failure. 2021;23:1577–1596. doi:10.1002/ejhf.2339.