Article open access publication

Additive prognostic value of plasma N-terminal pro-brain natriuretic peptide and coronary artery calcification for cardiovascular events and mortality in asymptomatic patients with type 2 diabetes

Cardiovascular Diabetology, Springer Nature, ISSN 1475-2840

Volume 14, 1, 2015

DOI:10.1186/s12933-015-0225-0, Dimensions: pub.1043805306, PMC: PMC4489401, PMID: 25990319,



  1. (1) Steno Diabetes Center, grid.419658.7, Capital Region
  2. (2) Center for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, University of Copenhagen, Compenhagen, Denmark
  3. (3) Frederiksberg Hospital, grid.415046.2, Capital Region
  4. (4) Gentofte Hospital, grid.411646.0, Capital Region
  5. (5) University of Copenhagen, grid.5254.6, KU
  6. (6) Rigshospitalet, grid.475435.4, Capital Region
  7. (7) Aarhus University, grid.7048.b, AU






BACKGROUND: In 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. METHODS: Prospective 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). RESULTS: High-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). CONCLUSIONS: In 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.

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