title: Prognostic role of B-type natriuretic peptide levels in patients with type 2 diabetes mellitus.
abstract: OBJECTIVE
  We hypothesized that B-type natriuretic peptide (BNP) levels can predict cardiac mortality in diabetic patients.
  
  
  BACKGROUND
  Detection of cardiovascular disease in diabetics can be difficult until overt events occur.
  
  
  METHODS
  A total of 482 diabetics (majority male with type 2 diabetes) at the Veterans Affairs Medical Center San Diego were divided into two groups: 1) referred patients for echocardiogram on the basis of clinical suspicion of cardiac dysfunction (referred [R], n = 180); 2) patients randomly selected from the diabetic clinic without any suspicion of cardiac dysfunction (not referred [N-R], n = 302). We examined cardiac events and all-cause mortality in relation to initial BNP levels during the follow-up.
  
  
  RESULTS
  A total of 71 (14.7%) patients died during this period: 52 of 180 (29%) in the R group (30 of 52 [58%] cardiac, 10 of 52 [19%] non-cardiac, 2 of 52 [4%] renal, 10 of 52 [19%] unknown cause) and 19 of 302 (6%) in N-R group (6 of 19 [32%] cardiac). The median BNP level in the R and N-R groups who died of cardiac, non-cardiac, and unknown cause was 537 and 87, 80 and 53, and 343 and 38 pg/ml, respectively. The receiver-operating characteristic (ROC) values for mortality in two groups in relation to BNP revealed the area under the curve to be 0.720 and 0.691, respectively (p < 0.01 in both). Among commonly used prognostic indicators in diabetics, only the ROC for triglycerides was significant. The most accurate cut-point in both the N-R group (87%) and R group (61%) was 120 pg/ml of BNP. Cox regression analysis showed BNP to be the most significant predictor of all-cause mortality in the R group. There was a marked decrease in survival in the patient group with BNP >120 pg/ml.
  
  
  CONCLUSIONS
  B-type natriuretic peptide appears to be a reliable predictor of future cardiac and all-cause mortality in diabetic patients.
authors.affiliation: Division of Cardiology, Veteran's Affairs Medical Center, San Diego, California 92161, USA.
authors.forename: Meenakshi A
authors.initials: MA
authors.lastname: Bhalla
authors.forename: Audrey
authors.initials: A
authors.lastname: Chiang
authors.forename: Victoria A
authors.initials: VA
authors.lastname: Epshteyn
authors.forename: Radmila
authors.initials: R
authors.lastname: Kazanegra
authors.forename: Vikas
authors.initials: V
authors.lastname: Bhalla
authors.forename: Paul
authors.initials: P
authors.lastname: Clopton
authors.forename: Padma
authors.initials: P
authors.lastname: Krishnaswamy
authors.forename: L K
authors.initials: LK
authors.lastname: Morrison
authors.forename: Albert
authors.initials: A
authors.lastname: Chiu
authors.forename: Nancy
authors.initials: N
authors.lastname: Gardetto
authors.forename: Sunder
authors.initials: S
authors.lastname: Mudaliar
authors.forename: Steven V
authors.initials: SV
authors.lastname: Edelman
authors.forename: Robert R
authors.initials: RR
authors.lastname: Henry
authors.forename: Alan S
authors.initials: AS
authors.lastname: Maisel
mesh_terms: D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000401:mortality / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000097:blood / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014280:Triglycerides / Q000097:blood
chemical_list: D014280:Triglycerides; D020097:Natriuretic Peptide, Brain