title: N-terminal pro-brain natriuretic peptide and risk of cardiovascular events in older patients with type 2 diabetes: the Edinburgh Type 2 Diabetes Study.
abstract: OBJECTIVE
  The aim of this study was to investigate the association of N-terminal pro-brain natriuretic peptide (NT-proBNP) with traditional cardiovascular risk factors and incident cardiovascular events in older people with type 2 diabetes.
  
  
  METHODS
  In the prospective phase of the Edinburgh Type 2 Diabetes Study, 1066 men and women aged 60 to 75 years with type 2 diabetes mellitus were followed for 4 years; 112 participants had an incident cardiovascular event. At baseline, cardiovascular risk factors, pre-existing cardiovascular disease and levels of NT-proBNP were evaluated.
  
  
  RESULTS
  Raised plasma NT-proBNP levels were associated with these classical cardiovascular risk factors: increased duration of diabetes, use of insulin, raised BMI, reduced HDL-cholesterol, reduced renal function and use of lipid-lowering and anti-hypertensive medication (all p < 0.05). In the prospective analysis, NT-proBNP was strongly associated with subsequent risk of all cardiovascular disease events (HR per one SD increase in NT-proBNP 1.39; 95% CI 1.10, 1.75), independent of cardiovascular risk factors traditionally used to predict vascular events. NT-proBNP was also independently associated with incident coronary artery disease events (1.48, 95% CI 1.10, 1.98). The addition of NT-proBNP to multivariate models improved the C-index by 0.019 for the 'hard' cardiac endpoint (fatal and non-fatal myocardial infarction).
  
  
  CONCLUSIONS
  In older people with type 2 diabetes, NT-proBNP is associated with the development of coronary and cerebrovascular events, independent of a wide range of other vascular and metabolic risk factors, and may prove a useful addition to current vascular risk scores in diabetes populations.
authors.affiliation: Centre for Population Health Sciences, The University of Edinburgh Medical School, Teviot Place, Edinburgh, Scotland, EH8 9AG, UK, s1356205@sms.ed.ac.uk.
authors.forename: Anna H
authors.initials: AH
authors.lastname: Price
authors.forename: Paul
authors.initials: P
authors.lastname: Welsh
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Weir
authors.forename: Insa
authors.initials: I
authors.lastname: Feinkohl
authors.forename: Christine M
authors.initials: CM
authors.lastname: Robertson
authors.forename: Joanne R
authors.initials: JR
authors.lastname: Morling
authors.forename: Stela
authors.initials: S
authors.lastname: McLachlan
authors.forename: Mark W J
authors.initials: MW
authors.lastname: Strachan
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
authors.forename: Jackie F
authors.initials: JF
authors.lastname: Price
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain