Longitudinal assessment of N-terminal pro-B-type natriuretic peptide and risk of diabetes in older adults: The cardiovascular health study.
Natriuretic peptides have a well-recognized role in cardiovascular homeostasis. Recently, higher levels of B-type natriuretic peptide (BNP) have also been associated with decreased risk of diabetes in middle-aged adults. Whether this association persists into older age, where the pathophysiology of diabetes changes, has not been established, nor has its intermediate pathways.



We investigated the relationship between N-terminal (NT)-proBNP and incident diabetes in 2359 older adults free of cardiovascular disease or chronic kidney disease in the Cardiovascular Health Study.



We documented 348 incident cases of diabetes over 12.6years of median follow-up. After adjusting for age, sex, race, body mass index, systolic blood pressure, anti-hypertensive treatment, smoking, alcohol use, and LDL, each doubling of NT-proBNP was associated with a 9% lower risk of incident diabetes (HR=0.91 [95% CI: 0.84-0.99]). Additional adjustment for waist circumference, physical activity, estimated glomerular filtration rate or C-reactive protein did not influence the association. Among putative mediators, HDL and triglycerides, adiponectin, and especially homeostasis model assessment of insulin resistance, all appeared to account for a portion of the lower risk associated with NT-proBNP.



In older adults without prevalent cardiovascular or kidney disease, higher NT-proBNP is associated with decreased risk of incident diabetes even after adjustment for traditional risk factors. These findings suggest that the metabolic effects of natriuretic peptides persist late in life and offer a potential therapeutic target for prevention of diabetes in older people.
Albert Einstein College of Medicine, Bronx, NY, USA. Electronic address: Erika.brutsaert@einstein.yu.edu.
Erika F
EF
Brutsaert
University of Washington, Seattle, WA, USA.
Mary L
ML
Biggs
University of Washington, Seattle, WA, USA.
Joseph A
JA
Delaney
Brigham and Women's Hospital, Boston, MA, USA.
Luc
L
Djoussé
University of Maryland Medical Center, Baltimore, MD, USA.
John S
JS
Gottdiener
University of California San Diego, School of Medicine, La Jolla, CA, USA.
Joachim H
JH
Ix
University of Washington, Seattle, WA, USA.
Francis
F
Kim
Beth Israel Deconness Medical Center, Boston, MA, USA.
Kenneth J
KJ
Mukamal
New York Academy of Medicine, New York, NY, USA.
David S
DS
Siscovick
University of Vermont, Burlington, VT, USA.
Russell P
RP
Tracy
University of Washington, Seattle, WA, USA.
Ian H
IH
de Boer
University of Maryland Medical Center, Baltimore, MD, USA.
Christopher R
CR
deFilippi
Albert Einstein College of Medicine, Bronx, NY, USA.
Jorge R
JR
Kizer
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000097:blood* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D018570:Risk Assessment; D012307:Risk Factors
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
BNP; Diabetes; Elders; Natriuretic peptide