Introduction and Objective: Heart failure (HF) is common in diabetes and may be asymptomatic in earlier stages. NT-proBNP and BNP [collectively natriuretic peptides (NP)] detect early HF in asymptomatic individuals who could benefit from disease-modifying therapies. We examined the prognostic value of NP levels in people with type 1 (T1D) or type 2 (T2D) diabetes without known HF.Methods: We retrospectively evaluated adults (≥18 years) with T1D or T2D using Optum’s de-identified Market Clarity Data who received an outpatient NP test between 2017-2023 without known HF at time of testing. We categorized BNP levels as <50, 50-100 or >100 and NT-proBNP levels as <125, 125-300 or >300. We assessed the association between NP levels and HF development or death using Cox proportional hazard models, adjusting for age, sex, race, ethnicity, comorbidities and region.Results: Among 116,439 people (3,284 with T1D and 113,155 with T2D) who met inclusion criteria and were followed up to 7 years, 54% were female, had a median (IQR) age of 64 (55-74) and a mean (SD) A1c of 7.2% (1.8) at baseline. Overall, 28,239 individuals (24%) had incident HF or death during follow-up (median 26 months). Roughly 18% of people with T1D and 19% with T2D had BNP 50-100 or NT-proBNP 125-300; 22% of those with T1D and 23% with T2D had BNP >100 or NT-proBNP >300. In adjusted Cox models, increased NT-ProBNP was significantly associated with increased risk of HF development or mortality among individuals with T1D (HR [95% CI] NT-ProBNP 125-300: 2.06 [1.40-3.06]; >300: 5.25 [3.75-7.36], ref: NT-ProBNP<125) and T2D (HR [95% CI] NT-ProBNP 125-300: 1.90 [1.79-2.02]; >300: 3.70 [3.51-3.91]). BNP showed a similar prognostic pattern.Conclusion: These data demonstrate that NP test results in individuals with diabetes without HF are highly prognostic for future risk of HF or mortality. The study supports implementation of NP testing for HF risk assessment in people with T1D and T2D for optimal management and improved outcomes.
R. Pop-Busui: Board Member; American Diabetes Association. Consultant; Averitas Pharma, Inc. Research Support; Bayer Pharmaceuticals, Inc. Other Relationship; Biogen. Research Support; Juvenile Diabetes Research Foundation (JDRF). Advisory Panel; Lexicon Pharmaceuticals, Inc, Novo Nordisk. Research Support; Novo Nordisk, National Institute of Diabetes and Digestive and Kidney Diseases. Consultant; Roche Diagnostics. E. Repetto: Employee; Roche Diagnostics. J.M. Baron: Employee; Roche Diagnostics. Stock/Shareholder; Roche Diagnostics. D. Schumacher: Employee; Roche Diagnostics. M. Vaduganathan: Advisory Panel; American Regent, Amgen, AstraZeneca, Bayer AG, Baxter Healthcare, BMS, Boehringer Ingelheim, Chiesi, Cytokinetics, Fresenius Medical Care, Idorsia Pharmaceuticals, Lexicon Pharmaceuticals, Merck, Mile, Pharmacosmos, Relypsa, Roche Diagnostics, Sanofi, and Tricog Health. Research Support; AstraZeneca, Galmed, Novartis, Bayer AG, Occlutech, and Impulse Dynamics. A. Pandey: Consultant; Roche Diagnostics. Advisory Panel; Bayer Pharmaceuticals, Inc, Novo Nordisk. Other Relationship; Lilly USA LLC. Consultant; Edwards Lifesciences. Other Relationship; Merck & Co., Inc, Rivus Pharmaceuticals Inc, Ultromics. Consultant; Tricog Health, Sarfez Pharma, Axon Therapies. Other Relationship; Alleviant.
A part of the work was funded by Roche Diagnostics Corporation (Indianapolis, IN, USA); RPB was supported by 1-R01-DK126837-01A1
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