Abstract
BackgroundIn patients with type 2 diabetes, cardiovascular disease (CVD) is the major cause of morbidity and mortality. We evaluated the combination of NT-proBNP and coronary artery calcium score (CAC) for prediction of combined fatal and non-fatal CVD and mortality in patients with type 2 diabetes and microalbuminuria (>30 mg/24-h), but without known coronary artery disease. Moreover, we assessed the predictive value of a predefined categorisation of patients into a high- and low-risk group at baseline.MethodsProspective study including 200 patients. All received intensive multifactorial treatment. Patients with baseline NT-proBNP >45.2 ng/L and/or CAC ≥400 were stratified as high-risk patients (n = 133). Occurrence of fatal- and nonfatal CVD (n = 40) and mortality (n = 26), was traced after 6.1 years (median).ResultsHigh-risk patients had a higher risk of the composite CVD endpoint (adjusted hazard ratio [HR] 10.6 (95 % confidence interval [CI] 2.4-46.3); p = 0.002) and mortality (adjusted HR 5.3 (95 % CI 1.2-24.0); p = 0.032) compared to low-risk patients. In adjusted continuous analysis, both higher NT-proBNP and CAC were strong predictors of the composite CVD endpoint and mortality (p ≤ 0.0001). In fully adjusted models mutually including NT-proBNP and CAC, both risk factors remained associated with risk of CVD and mortality (p ≤ 0.022). There was no interaction between NT-proBNP and CAC for the examined endpoints (p ≥ 0.31).ConclusionsIn patients with type 2 diabetes and microalbuminuria but without known coronary artery disease, NT-proBNP and CAC were strongly associated with fatal and nonfatal CVD, as well as with mortality. Their additive prognostic capability holds promise for identification of patients at high risk.
Highlights
In patients with type 2 diabetes, cardiovascular disease (CVD) is the major cause of morbidity and mortality
In a type 2 diabetic population followed for 15 years, we previously identified plasma NT-proBNP levels as a powerful predictor of mortality, independent of urinary albumin excretion rate (UAER) and other risk factors [10]
We evaluate the joint predictive value of NTproBNP and calcium score (CAC) for combined fatal and non-fatal CVD, and all-cause mortality, respectively, in patients with type 2 diabetes and microalbuminuria, but without known coronary artery disease (CAD)
Summary
In patients with type 2 diabetes, cardiovascular disease (CVD) is the major cause of morbidity and mortality. Compared with subjects without diabetes, the risk of cardiovascular complications is two to four times increased, and is even higher in patients with diabetes and established albuminuria [1, 2]. Several risk scores have been developed to estimate the cardiovascular risk in asymptomatic subjects. The Framingham Risk Score is the most commonly applied. We evaluated the combination of NT-proBNP and coronary artery calcium score (CAC) for prediction of combined fatal and non-fatal CVD and mortality in patients with type 2 diabetes and microalbuminuria (>30 mg/24-h), but without known coronary artery disease. We assessed the predictive value of a predefined categorisation of patients into a high- and low-risk group at baseline
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