Background and Aims. The identification of type 2 diabetes mellitus (T2DM) patients with high cardio-vascular risk became more crucial, especially in patients with known coronary artery disease (CAD). Our study is focusing on T2DM patients who suffered recently an acute coronary syndrome (ACS), and evaluates the importance of albuminuria and NT-proBNP level as risk factors for short-term recurrence.
Material and methods. 221 T2DM patients with recent ACS were evaluated 1 month after discharge, assessing NT-proBNP and albuminuria level and followed for 12 months for major adverse cardiac events (MACE).
Results. Patients who reached the endpoint (33%) presented significantly higher levels of NT-proBNP (458.5 vs. 207.4 pg/ml, p<0.0001) and urinary albumin/creatinine ratio (80 vs. 27 mg/g, p<0.0001) than those who did not present a MACE in the follow-up period. Comparison of the MACE-free survival curves revealed that NT-proBNP has a better power than albuminuria in the prediction of the short-term outcome: hazard ratio (HR)=1.6176 (95%CI: 1.0047-2.6044), p=0.0433 vs. HR=1.4813 (95%CI: 0.8497-2.5824), p=0.1921. Only the NT-proBNP level entered the multivariable regression model besides age and represents an independent risk factor (HR=1.0025, 95%CI: 1.0014-1.0035, p=0.0036).
Conclusion. NT-proBNP provides excellent prognostic information in patients with diabetes mellitus who recently suffered an ACS. Albuminuria wasn’t an independent risk factor in this cohort.
1. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 27: 1047-1053, 2004.
2. Panzram G. Mortality and survival in type 2 (non-insulindependent) diabetes mellitus. Diabetologia 30: 123-131, 1987.
3. Pahor M, Elam MB, Garrison RJ, Kritchevsky SB, Applegate WB. Emerging noninvasive biochemical measures to predict cardiovascular risk. Arch Intern Med 159: 237-245, 1999.
4. Gerstein HC, Mann JF, Pogue J et al. Prevalence and determinants of microalbuminuria in high - risk diabetic and nondiabetic patients in the Heart Outcomes Prevention Evaluation Study. The HOPE Study Investigators. Diabetes Care 23[Suppl 2]: B35-B39, 2000.
5. Stehouwer CD, Henry RM, Dekker JM, Nijpels G, Heine RJ, Bouter LM. Microalbuminuria is associated with impaired brachial artery, flow-mediated vasodilation in elderly individuals without and with diabetes: further evidence for a link between microalbuminuria and endothelial dysfunction - the Hoorn Study. Kidney Int Suppl (92): S42-S44, 2004.
6. Quyyumi AA. Prognostic value of endothelial function. Am J Cardiol 91(12A): 19H-24H, 2003.
7. Adler AI, Boyko EJ, Ahroni JH, Smith DG. Lower extremity amputation in diabetes. The independent effects of peripheral vascular disease, sensory neuropathy, and foot ulcers. Diabetes Care 22: 1029-1035, 1999.
8. Valmadrid CT, Klein R, Moss SE, Klein BE. The risk of cardiovascular disease mortality associated with microalbuminuria and gross proteinuria in persons with older-onset diabetes mellitus. Arch Intern Med 160: 1093-1100, 2000.
9. Mattock MB, Barnes DJ, Viberti G et al. Microalbuminuria and coronary heart disease in NIDDM: an incidence study. Diabetes 47: 1786-1792, 1998.
10. Gerstein HC, Mann JF, Yi Q et al. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA 286: 421-426, 2001.
11. Mogensen CE. Microalbuminuria predicts clinical proteinuria and early mortality in maturity onset diabetes. N Engl J Med 310: 356-360, 1984.
12. Jackson CE, Solomon SD, Gerstein HC et al. Albuminuria in chronic heart failure: prevalence and prognostic importance. Lancet 374(9689):543-550, 2009.
13. Omland T, de Lemos JA, Sabatine MS et al. A sensitive cardiac troponin T assay in stable coronary artery disease. N Engl J Med 361: 2538-2547, 2009.
15. Gaede P, Hildebrandt P, Hess G, Parving HH, Pedersen O. Plasma N-terminal pro-brain natriuretic peptide as a major risk marker for cardiovascular disease in patients with type 2 diabetes and microalbuminuria. Diabetologia 48: 156-163, 2005.
16. Kistorp C, Raymond I, Pedersen F, Gustafsson F, Faber J, Hildebrandt P. N-terminal pro-brain natriuretic peptide, C-reactive protein, and urinary albumin levels as predictors of mortality and cardiovascular events in older adults. JAMA 293: 1609-1616, 2005.
17. Tarnow L, Gall MA, Hansen BV, Hovind P, Parving HH. Plasma N-terminal pro-B-type natriuretic peptide and mortality in type 2 diabetes. Diabetologia 49: 2256-2262, 2006.
18. ADVANCE Collaborative Group, Patel A, MacMahon S et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 358: 2560-2572, 2008.
19. ACCORD Study Group, Gerstein HC, Miller ME et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 358: 2545-2559, 2008.
20. Duckworth W, Abraira C, Moritz T et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 360: 129-139, 2009.
21. ACCORD Study Group, Ginsberg HN, Elam MB et al. Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med 362: 1563-1574, 2010.
22. ACCORD Study Group, Cushman WC, Evans GW et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 362: 1575-1585, 2010.
23. Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 348: 383-393, 2003.
24. Amsterdam EA, Wenger NK, Brindis RG et al. 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines J Am Coll Cardiol 64: e139-e228, 2014.
25. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 33[Suppl. 1]: S62–S69, 2010.
26. Lavi S, Kapeliovich M, Gruberg L et al. Hyperglycemia during acute myocardial infarction in patients who are treated by primary percutaneous coronary intervention: impact on long-term prognosis. Int J Cardiol 123: 117–122, 2008.
27. Asakawa H, Fukui T, Tokunaga K, Kawakami F. Plasma brain natriuretic peptide levels in normotensive Type 2 diabetic patients without cardiac disease and macroalbuminuria. J Diabetes Complications 16: 209-213, 2002.