title: Plasma NT-proBNP and white matter hyperintensities in type 2 diabetic patients.
abstract: Elevated plasma N-terminal (NT)-proBNP from the heart as well as white matter hyperintensities (WMH) in the brain predict cardiovascular (CV) mortality in the general population. The cause of poor prognosis associated with elevated P-NT-proBNP is not known but WMH precede strokes in high risk populations. We assessed the association between P-NT-proBNP and WMH or brain atrophy measured with magnetic resonance imaging (MRI) in type 2 diabetic patients, and age-matched controls.
  
  
  RESULTS
  We measured P-NT-proBNP(ng/l) in 20 diabetic patients without prior stroke but with(n=10) or without(n=10) asymptomatic coronary artery disease(CAD) in order to include patients with a wide-ranging CV risk profile. All patients and 26 controls had a 3D MRI and brain volumes(ml) with WMH and brain parenchymal fraction(BPF), an indicator of brain atrophy, were determined.P-NT-proBNP was associated with WMH in linear regression analysis adjusted for CV risk factors(r=0.94, p=0.001) and with BPF in univariate analysis(r=0.57, p=0.009). Patients divided into groups of increased P-NT-proBNP levels were paralleled with increased WMH volumes(geometric mean[SD];(2.86[5.11] ml and 0.76[2.49] ml compared to patients with low P-NT-proBNP 0.20[2.28] ml, p=0.003)) and also when adjusted for age, sex and presence of CAD(p=0.017). The association was strengthened by CV risk factors and we did not find a common heart or brain specific driver of both P-NT-proBNP and WMH. Patients and particular patients with CAD had higher WMH, however no longer after adjustment for age and sex.
  
  
  CONCLUSIONS
  P-NT-proBNP was associated with WMH in type 2 diabetic patients, suggesting a linkage between heart and brain disease.
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark. hrhl@dadlnet.dk
authors.forename: Henrik
authors.initials: H
authors.lastname: Reinhard
authors.forename: Ellen
authors.initials: E
authors.lastname: Garde
authors.forename: Arnold
authors.initials: A
authors.lastname: Skimminge
authors.forename: Per
authors.initials: P
authors.lastname: Åkeson
authors.forename: Thomas Zoëga
authors.initials: TZ
authors.lastname: Ramsøy
authors.forename: Kaj
authors.initials: K
authors.lastname: Winther
authors.forename: Hans-Henrik
authors.initials: HH
authors.lastname: Parving
authors.forename: Peter
authors.initials: P
authors.lastname: Rossing
authors.forename: Peter K
authors.initials: PK
authors.lastname: Jacobsen
mesh_terms: D000328:Adult; D000368:Aged; D001284:Atrophy; D015415:Biomarkers / Q000097:blood; D001921:Brain / Q000473:pathology*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000097:blood / Q000209:etiology* / Q000473:pathology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D056784:Leukoencephalopathies / Q000097:blood / Q000209:etiology* / Q000473:pathology; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009929:Organ Size; D010446:Peptide Fragments / Q000097:blood*; D018570:Risk Assessment; D012307:Risk Factors; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain