title: Changes in N-terminal pro-B-type natriuretic peptide and incidence of diabetes: The Multi-Ethnic Study of Atherosclerosis (MESA).
abstract: OBJECTIVE
  This study looked at whether the inverse association of circulating N-terminal pro-B-type natriuretic peptide (NT-proBNP) with incident diabetes is modified by changes in NT-proBNP (ΔNT-proBNP) levels.
  
  
  METHODS
  Plasma NT-proBNP was assayed at baseline and 3.2 years later (visit 3) in the Multi-Ethnic Study of Atherosclerosis (MESA). ΔNT-proBNP was calculated as NT-proBNP visit3-NT-proBNP baseline. A Poisson distribution was fitted to determine the incidence density of diabetes, adjusted for age, race, gender, educational attainment, antihypertensive medication, total intentional exercise and plasma IL-6 levels. In the primary analysis (n=3236 without diabetes up to visit 3, followed for a mean of 6.3 years), incidence density was regressed for the following categories of baseline NT-proBNP: (1)<54.4 pg/mL; (2) 54.4-85.9 pg/mL; and (3) 86-54.2 pg/mL. This was crossed with categories of ΔNT-proBNP as medians (ranges): (1) -6.2 (-131-11.7) pg/mL; (2) 19.8 (11.8-30.1) pg/mL; (3) 44.0 (30.2-67.9) pg/mL; and (4) 111.2 (68.0-3749.9) pg/mL.
  
  
  RESULTS
  The incidence density of diabetes followed a U-shaped association across categories of ΔNT-proBNP within categories of baseline NT-proBNP after adjusting for other covariates (P=0.02). At each level of baseline NT-proBNP, the incidence density of diabetes was lowest for small-to-moderate increases in NT-proBNP.
  
  
  CONCLUSIONS
  This analysis suggests that NT-proBNP has a biphasic association with diabetes in which the risk of incident diabetes decreases within a 'physiological range' of ΔNT-proBNP, and plateaus or increases as NT-proBNP concentrations increase, probably in response to pathophysiological conditions leading to high levels of NT-proBNP.
authors.affiliation: School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, West Bank Office Building 1300 South, Second Street, Suite 300, 55454-1015 Minneapolis, United States. Electronic address: sanc0050@umn.edu.
authors.forename: O A
authors.initials: OA
authors.lastname: Sanchez
authors.affiliation: Division of Cardiology, University of Minnesota, United States.
authors.forename: D A
authors.initials: DA
authors.lastname: Duprez
authors.affiliation: Stanford University, United States.
authors.forename: H
authors.initials: H
authors.lastname: Bahrami
authors.affiliation: School of Medicine, University of California San Francisco, United States.
authors.forename: C A
authors.initials: CA
authors.lastname: Peralta
authors.affiliation: Division of Cardiology, University of California, San Diego, United States.
authors.forename: L B
authors.initials: LB
authors.lastname: Daniels
authors.affiliation: Division of Cardiology, Johns Hopkins Bayview Medical Center, United States.
authors.forename: J A
authors.initials: JA
authors.lastname: Lima
authors.affiliation: School of Medicine, University of California, San Diego, United States.
authors.forename: A
authors.initials: A
authors.lastname: Maisel
authors.affiliation: School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, West Bank Office Building 1300 South, Second Street, Suite 300, 55454-1015 Minneapolis, United States.
authors.forename: A R
authors.initials: AR
authors.lastname: Folsom
authors.affiliation: School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, West Bank Office Building 1300 South, Second Street, Suite 300, 55454-1015 Minneapolis, United States.
authors.forename: D R
authors.initials: DR
authors.lastname: Jacobs
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases / Q000453:epidemiology; D050197:Atherosclerosis / Q000097:blood* / Q000453:epidemiology / Q000276:immunology; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000453:epidemiology / Q000276:immunology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D016012:Poisson Distribution; D012306:Risk; D015854:Up-Regulation
chemical_list: C508600:IL6 protein, human; D015850:Interleukin-6; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Change; Diabetes; Incidence; MESA study; NT-proBNP; Natriuretic peptides