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Natriuretic peptide may help identify diabetic patients at risk for silent CAD
1 July 2009
MedWire News: N-terminal pro-B-type natriuretic peptide (NT-proBNP) may be a useful predictor for silent coronary artery disease (CAD) in asymptomatic diabetic patients without clinical signs or symptoms of heart failure, research shows.
Early identification of diabetic patients with silent CAD may reduce morbidity and mortality, but to select patients who might benefit from screening, simple biological markers are required.
To determine whether plasma levels of NT-proBNP, a marker for cardiac failure, predicts silent myocardial ischemia and silent CAD in asymptomatic high-risk patients with diabetes, Emmanuel Cosson (Jean Verdier Hospital, Bondy, France) and co-workers prospectively screened 517 patients with Type 1 or with Type 2 diabetes and at least one additional cardiovascular risk factor between 1998 and 2008.
The participants had no clinical signs or symptoms of heart failure. Silent myocardial ischemia was assessed by stress myocardial scintigraphy and cardiac function by echocardiography. Data from 323 patients with both echocardiography results and stored plasma samples for NT-proBNP measurements were available.
NT-proBNP levels were analyzed by tertile defined as less than 14 pg/ml, 14–37 pg/ml, and at least 38 pg/ml.
As reported in the journal Diabetic Medicine, the authors identified silent myocardial ischemia in 108 (33.4%) patients, 39 of whom had CAD.
Levels of NT-proBNP were 45 pg/ml in patients with CAD compared with 20 pg/ml in patients without CAD, and remained statistically significantly higher in patients with CAD even after adjustment for confounding factors.
The highest tertile of plasma NT-proBNP levels was associated with a significantly higher prevalence of silent myocardial ischemia and CAD, and predicted CAD with a sensitivity of 59% and a specificity of 67%.
In multiple logistic regression analyses, which included NT-proBNP of at least 38 pg/ml, age, body mass index, gender, glycated hemoglobin, hypertension, retinopathy, nephropathy, peripheral occlusive arterial disease, and measures of left ventricular structure and function, an NT-proBNP level of at least 38 pg/ml was the only significant independent predictor of silent CAD, with an odds ratio of 3.1.
The authors suggest that the applicability of the NT-proBNP measurement and its prognostic value deserve further testing in larger studies.
“NT-proBNP measurement helps to better define asymptomatic diabetic patients with an increased likelihood for CAD, independently of cardiac function and structure,” they conclude.
