NT-proBNP May Predict Cardiovascular Outcomes in Type 2 Diabetes

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Changes in N-terminal B-type natriuretic peptide levels from baseline and 6 months were associated with adverse outcomes.

N-terminal B-type natriuretic peptide (NT-proBNP) concentration may be beneficial for identifying patients at high risk for adverse cardiovascular (CV) outcome in patients with type 2 diabetes who were stable after an acute coronary syndrome (ACS) event, according to a prospective study published in Diabetes Care.

Participants were recruited from the Examination of Cardiovascular Outcomes With Alogliptin Versus Standard of Care (EXAMINE) trial. This study included patients with type 2 diabetes who experienced an ACS event within 15 to 90 days of enrollment (n=5380) who were randomly assigned to receive either alogliptin or placebo. The primary end point was CV death or hospitalization for heart failure (HF).

Results evidenced associations between increasing NT-proBNP concentrations at baseline and 6 months and the incidence of major CV events (both P <.001); adjustments were made for potential confounders. Furthermore, patients who had high NT-proBNP at 6 months were at a higher risk for CV death or hospitalization for HF than patients with low NT-proBNPs (P <.001).

Administration of alogliptin did not affect NT-proBNP concentrations. No significant adverse effects from alogliptin were documented.

The study may be limited by its requirement that participants had a recent ACS; patients suffering from chronic ischemic heart disease were not assessed.

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 “These results lend additional support to the notion of using natriuretic peptides for serial monitoring of patients with diabetes and ischemic heart disease whose diseases are in a seemingly clinically stable phase,” the authors wrote. “Such monitoring may prove useful as clinicians consider treatment for individual patients using new or established therapies that may adversely or positively affect the risk of incident HF events in patients with type 2 diabetes and known CV disease.”

Disclosures: Multiple authors report affiliations with the pharmaceutical industry; please refer to the full-length text for a complete list.


Jarolim P, White WB, Cannon CP, et al. Serial measurement of natriuretic peptides and cardiovascular outcomes in patients with type 2 diabetes mellitus in the EXAMINE Trial. Diabetes Care. 2018;41(7):1510-1515.