title: N-terminal probrain natriuretic peptide is a stronger predictor of cardiovascular mortality than C-reactive protein and albumin excretion rate in elderly patients with type 2 diabetes: the Casale Monferrato population-based study.
abstract: OBJECTIVE
  To study whether N-terminal probrain natriuretic peptide (NT-proBNP) is a short-term independent predictor of both all-cause and cardiovascular (CV) mortality in type 2 diabetic patients and to establish whether albuminuria and C-reactive protein (CRP) affect this relationship.
  
  
  METHODS
  The prospective study included 1,825 type 2 diabetic patients from the population-based cohort of the Casale Monferrato study. CV risk factors, preexisting CVD, and NT-proBNP levels were evaluated at baseline. All-cause and CV mortality were assessed 5.5 years after baseline examination. Multivariate Cox proportional hazards modeling was used to estimate mortality hazard ratios (HRs).
  
  
  RESULTS
  During the follow-up period, 390 people died (175 for CVD) out of 9,101 person-years of observations. A significantly increased mortality risk by quartiles of NT-proBNP was observed (test for trend, P < 0.001). NT-proBN P values >91 pg/mL conferred HRs of 2.05 (95% CI 1.47-2.86) for all-cause and 4.47 (2.38-8.39) for CV mortality, independently of CV risk factors, including CRP and albumin excretion rate (AER). The association was also significant for modest rises in NT-proBNP levels and in patients without microalbuminuria and CVD at baseline (upper quartiles HRs 3.82 [95% CI 1.24-13.75]) and 3.14 [1.00-9.94]). Albuminuria and NT-proBNP had an additive effect on mortality, though the association was stronger for NT-proBNP.
  
  
  CONCLUSIONS
  NT-proBNP is a strong independent predictor of short-term CV mortality risk in elderly people with type 2 diabetes, including those without preexisting CVD. This association is evident even in people with slightly increased values, is not modified by CRP, and is additive to that provided by AER.
authors.affiliation: Department of Medical Sciences, University of Turin, Turin, Italy. graziella.bruno@unito.it
authors.forename: Graziella
authors.initials: G
authors.lastname: Bruno
authors.forename: Andrea
authors.initials: A
authors.lastname: Landi
authors.forename: Federica
authors.initials: F
authors.lastname: Barutta
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ghezzo
authors.forename: Claudio
authors.initials: C
authors.lastname: Baldin
authors.forename: Laura
authors.initials: L
authors.lastname: Spadafora
authors.forename: Andrea
authors.initials: A
authors.lastname: Schimmenti
authors.forename: Tania
authors.initials: T
authors.lastname: Prinzis
authors.forename: Paolo
authors.initials: P
authors.lastname: Cavallo Perin
authors.forename: Gabriella
authors.initials: G
authors.lastname: Gruden
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000378:metabolism* / Q000401:mortality*; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D010446:Peptide Fragments / Q000378:metabolism*; D011446:Prospective Studies
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein
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