NT-proBNP levels, atherosclerosis and vascular function in asymptomatic type 2 diabetic patients with microalbuminuria: peripheral reactive hyperaemia index but not NT-proBNP is an independent predictor of coronary atherosclerosisReport as inadecuate




NT-proBNP levels, atherosclerosis and vascular function in asymptomatic type 2 diabetic patients with microalbuminuria: peripheral reactive hyperaemia index but not NT-proBNP is an independent predictor of coronary atherosclerosis - Download this document for free, or read online. Document in PDF available to download.

Cardiovascular Diabetology

, 10:71

First Online: 03 August 2011Received: 22 July 2011Accepted: 03 August 2011

Abstract

Intensive multifactorial treatment aimed at cardiovascular CV risk factor reduction in type 2 diabetic patients with microalbuminuria can diminish fatal and non-fatal CV. Plasma N-terminal NT-proBNP predicts CV mortality in diabetic patients but the utility of P-NT-proBNP in screening for atherosclerosis is unclear. We examined the interrelationship between P-NT-proBNP, presence of atherosclerosis and-or vascular dysfunction in the coronary, carotid and peripheral arteries in asymptomatic type 2 diabetic patients with microalbuminuria that received intensive multifactorial treatment.

Methods and ResultsP-NT-proBNP was measured in 200 asymptomatic type 2 patients without known cardiac disease that received intensive multifactorial treatment for CV risk reduction. Patients were examined for coronary, carotid and peripheral atherosclerosis, as defined by coronary calcium score ≥400, carotid intima-media thickness CIMT > 0.90 mm, ankle-brachial index < 0.90, and-or toe-brachial index < 0.64, respectively. Carotid artery compliance was also determined and the reactive hyperaemia index RHI measured by peripheral artery tonometry was used as a surrogate for endothelial function.

P-NT-proBNP was associated with atherosclerosis in the unadjusted analysis, but not after adjustment for conventional risk factors. P-NT-proBNP was not associated with vascular dysfunction. The prevalence of atherosclerosis in the coronary, carotid and peripheral arteries was 35%, 10% and 21% of all patients, respectively. In total 49% had atherosclerosis in one territory and 15.6% and 1.0% in two and three territories. Low RHI was an independent predictor of coronary atherosclerosis odds ratio CI, 2.60 1.15-5.88 and systolic blood pressure was the only independent determinant of CIMT 0.02 mm increase in CIMT per 10 mmHg increase in systolic blood pressure p = 0.003.

ConclusionsHalf of asymptomatic patients with type 2 diabetes mellitus and microalbuminuria had significant atherosclerosis in at least one vascular territory despite receiving intensive multifactorial treatment for CV risk reduction. Coronary atherosclerosis was most prevalent, whereas carotid disease was more rarely observed. RHI but not plasma NT-proBNP was predictive of coronary atherosclerosis.

List of abbreviationsABIAnkle-brachial index

AIAugmentation index

AUCAreas under the ROC curve

BMIBody mass index

CAGCoronary angiography

CCSCoronary calcium score

CIConfidence interval

CIMTCarotid intima-media thickness

CTACT angiography

CVCardiovascular

MPIMyocardial perfusion imaging

NT-proBNPN-terminal pro brain natriuretic peptide

OROdds ratio

PADPeripheral artery disease

RAASRenin-angiotensin-aldosterone-system

RHIReactive hyperaemia index

ROCReceiver operating characteristic

SDStandard deviation

TBIToe-brachial index

WHOWorld Health Organisation.

Electronic supplementary materialThe online version of this article doi:10.1186-1475-2840-10-71 contains supplementary material, which is available to authorized users.

Niels Wiinberg, Peter R Hansen, Andreas Kjær, Claus L Petersen, Kaj Winther, Hans-Henrik Parving, Peter Rossing and Peter K Jacobsen contributed equally to this work.

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Author: Henrik Reinhard - Niels Wiinberg - Peter R Hansen - Andreas Kjær - Claus L Petersen - Kaj Winther - Hans-Henrik Parving

Source: https://link.springer.com/article/10.1186/1475-2840-10-71







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