Opposing Associations of NT-proBNP With Risks of Diabetes and Diabetes-Related Complications

Birukov, Anna; Eichelmann, Fabian; Kuxhaus, Olga; Polemiti, Elli; Fritsche, Andreas; Wirth, Janine; Boeing, Heiner; Weikert, Cornelia

doi:10.2337/dc20-0553

Cited by 32 publications

(19 citation statements)

References 42 publications

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“…Fetuin-A correlated weakly directly with HDL-cholesterol (r = 0.14), non-HDL cholesterol (r = 0.08) and HbA 1c (r = 0.10), and BMI/waist circumference (r = 0.08), and inversely with physical activity (r = -0.12), after adjustment for age and sex, Additional file 1 : Table S1. Participants who developed vascular complications of diabetes were on average older, more likely to be men and had a more unfavorable cardiometabolic profile characterized by higher triglycerides, lower HDL-cholesterol and lower adiponectin [ 33 ]. The median follow-up time (IQR) from diabetes diagnosis on was 12.8 (10.5–15.1) years for microvascular complications and 13.4 (10.9–15.6) years for macrovascular complications.…”

Section: Resultsmentioning

confidence: 99%

Fetuin-A and risk of diabetes-related vascular complications: a prospective study

Birukov

Polemiti

Jäger

et al. 2022

Cardiovasc Diabetol

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Background Fetuin-A is a hepatokine which has the capacity to prevent vascular calcification. Moreover, it is linked to the induction of metabolic dysfunction, insulin resistance and associated with increased risk of diabetes. It has not been clarified whether fetuin-A associates with risk of vascular, specifically microvascular, complications in patients with diabetes. We aimed to investigate whether pre-diagnostic plasma fetuin-A is associated with risk of complications once diabetes develops. Methods Participants with incident type 2 diabetes and free of micro- and macrovascular disease from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam cohort (n = 587) were followed for microvascular and macrovascular complications (n = 203 and n = 60, respectively, median follow-up: 13 years). Plasma fetuin-A was measured approximately 4 years prior to diabetes diagnosis. Prospective associations between baseline fetuin-A and risk of complications were assessed with Cox regression. Results In multivariable models, fetuin-A was linearly inversely associated with incident total and microvascular complications, hazard ratio (HR, 95% CI) per standard deviation (SD) increase: 0.86 (0.74; 0.99) for total, 0.84 (0.71; 0.98) for microvascular and 0.92 (0.68; 1.24) for macrovascular complications. After additional adjustment for cardiometabolic plasma biomarkers, including triglycerides and high-density lipoprotein, the associations were slightly attenuated: 0.88 (0.75; 1.02) for total, 0.85 (0.72; 1.01) for microvascular and 0.95 (0.67; 1.34) for macrovascular complications. No interaction by sex could be observed (p > 0.10 for all endpoints). Conclusions Our data show that lower plasma fetuin-A levels measured prior to the diagnosis of diabetes may be etiologically implicated in the development of diabetes-associated microvascular disease.

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Section: Resultsmentioning

confidence: 99%

Fetuin-A and risk of diabetes-related vascular complications: a prospective study

Birukov

Polemiti

Jäger

et al. 2022

Cardiovasc Diabetol

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“…There are large differences in the length of hospital stay of very preterm infants among different regions ( 6 ). In general, infants with necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and nosocomial infection have a longer length of stay in the hospital ( 7 – 9 ).…”

Section: Introductionmentioning

confidence: 99%

Association Between NT-proBNP and Prolonged Length of Stay in Hospital Among Preterm Infants Born at 28–31 Weeks' Gestation

Luo

Lei

et al. 2022

Front. Pediatr.

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ObjectiveIn the early life of preterm infants, the relationship between heart function and length of hospitalization is unclear. This study aims to examine the association between serum NT-proBNP level on the 7th day (NT-proBNP7) after birth and length of hospitalization among preterm infants.MethodsA retrospective cohort study was conducted. Patients included 709 preterm infants born at 28–31 weeks' gestational age (GA) admitted to the NICU of the First Affiliated Hospital of Zhengzhou University between December 20, 2016, to April 31, 2021. Main outcome: Late discharge (postmenstrual age at discharge was in the fourth quartile (highest) among infants born at the same GA). Exposure factor: NT-proBNP7.ResultsWe observed increased prevalence ratios for late discharge among the tertile of logarithm of NT-proBNP7 level (LnNT-proBNP7) which was positive. Compared with the lowest tertile, infants in the highest tertile of LnNT-proBNP7 had an 8.4-fold increased probability of late discharge, and the results were consistent for the subgroups. Next, a non-linear (S-shaped) relationship between LnNT-proBNP7 and late discharge was observed, whose turning points were 7.5 and 9. The effect sizes and the confidence intervals on the left of the first turning point, between two turning points and on the right of the second turning point, were 0.6 (95% CI, 0.2–1.6), 5.0 (95% CI, 2.4–10.6), and 1.1 (95% CI, 0.2–6.1), respectively. In addition, the prevalence of BPD, NEC, nosocomial infection, or any of them was highest in the group of LnNT-proBNP7 ≥ 9, lowest in the group of LnNT-proBNP7 < 7.5.ConclusionHigher NT-proBNP7 levels were associated with longer hospitalization. The relationship between LnNT-proBNP7 and late discharge was S-shaped. LnNT-proBNP7 was positively related with late discharge when LnNT-proBNP7 was between 7.5 and 9.

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“…This can be done through the identification of additional biomarkers that provide incremental prognostic value beyond the SYNTAX II score. Recently, increasing evidence has suggested that NT-proBNP, an established biomarker for the diagnosis and prognosis of heart failure, is associated with the risk of incident diabetes (27,28) and diabetes-related microvascular and macrovascular complications (29). Moreover, higher NT-proBNP levels are associated with an increased risk of death and cardiovascular events in patients with diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, elevated NT-proBNP levels reflect the accumulation of cardiovascular risk factors. NT-proBNP has been correlated with macro-and microvascular complications (29), such as MI, stroke, peripheral arterial disease, and diabetesrelated nephropathy, retinopathy, and neuropathy, which all lead to poor cardiovascular outcomes. However, the exact mechanism in diabetic patients with MVD needs to be further elucidated.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Significance of Preprocedural N-Terminal Pro-B-Type Natriuretic Peptide Assessment in Diabetic Patients With Multivessel Coronary Disease Undergoing Revascularization

Wang

Cong

Zhang

et al. 2021

Front. Cardiovasc. Med.

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Background and Aims: The N-terminal pro-B-type natriuretic peptide (NT-proBNP) may predict adverse cardiovascular outcomes in patients with diabetes. However, its prognostic value in patients with multivessel disease (MVD) undergoing coronary revascularization remains unclear. This study aimed to evaluate the prognostic significance of preprocedural NT-proBNP levels in diabetic patients with MVD undergoing coronary revascularization.Methods: A total of 886 consecutive diabetic patients with MVD who underwent coronary revascularization were enrolled in this study. Patients were divided into quartiles according to their pre-procedural NT-proBNP levels. Kaplan-Meier curves and Cox regression analyses were performed to evaluate the risk of cardiovascular events, including all-cause death, cardiovascular death, myocardial infarction (MI), stroke, and major adverse cardiovascular events (MACE), according to the NT-proBNP quartiles.Results: During a median follow-up period of 4.2 years, 111 patients died (with 82 being caused by cardiovascular disease), 133 had MI, 55 suffered from stroke, and 250 experienced MACE. Kaplan-Meier curves demonstrated that NT-proBNP levels were significantly associated with higher incidences of all-cause death, cardiovascular death, MI, and MACE (log-rank test, P < 0.001, respectively). Multivariate Cox regression analysis revealed that NT-proBNP level was an independent predictor of adverse outcomes, including all-cause death (HR, 1.968; 95% CI, 1.377–2.812; P < 0.001), cardiovascular death (HR, 1.940; 95% CI, 1.278–2.945; P = 0.002), MI (HR, 1.722; 95% CI, 1.247–2.380; P = 0.001), and MACE (HR, 1.356; 95% CI, 1.066–1.725; P = 0.013). The role of NT-proBNP in predicting adverse outcomes was similar in patients with stable angina pectoris and acute coronary syndrome. Moreover, preprocedural NT-proBNP alone discriminated against the SYNTAX II score for predicting all-cause death [area under the curve (AUC), 0.662 vs. 0.626, P = 0.269], cardiovascular death (AUC, 0.680 vs. 0.622, P = 0.130), MI (AUC, 0.641 vs. 0.579, P = 0.050), and MACE (AUC, 0.593 vs. 0.559, P = 0.171). The addition of NT-proBNP to the SYNTAX II score showed a significant net reclassification improvement, integrated discrimination improvement, and improved C-statistic (all P < 0.05).Conclusion: NT-proBNP levels were an independent prognostic marker for adverse outcomes in diabetic patients with MVD undergoing coronary revascularization, suggesting that preprocedural NT-proBNP measurement might help in the risk stratification of high-risk patients.

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Opposing Associations of NT-proBNP With Risks of Diabetes and Diabetes-Related Complications

Cited by 32 publications

References 42 publications

Fetuin-A and risk of diabetes-related vascular complications: a prospective study

Fetuin-A and risk of diabetes-related vascular complications: a prospective study

Association Between NT-proBNP and Prolonged Length of Stay in Hospital Among Preterm Infants Born at 28–31 Weeks' Gestation

Prognostic Significance of Preprocedural N-Terminal Pro-B-Type Natriuretic Peptide Assessment in Diabetic Patients With Multivessel Coronary Disease Undergoing Revascularization

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