Plasma N-terminal pro-brain natriuretic peptide as a major risk marker for cardiovascular disease in patients with type 2 diabetes and microalbuminuria
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Aims/hypothesis We examined whether plasma N-terminal probrain natriuretic peptide (NT-proBNP) predicts cardiovascular outcome in patients with type 2 diabetes. Methods A total of 160 microalbuminuric type 2 diabetic patients (mean age 55.1 years [SD 7.2], 119 men) were enrolled in the Steno-2 Study examining the effect of multifactorial treatment, and were divided into two groups according to baseline levels of plasma NT-proBNP below or above the median for the cohort, which was followed for an average of 7.8 years. Cardiovascular outcome was a composite of cardiovascular mortality, myocardial infarction, stroke, revascularisation procedures in the heart or legs, and amputations. Results In the whole group, plasma NT-proBNP being above the median was associated with an increased risk of cardiovascular disease during follow-up, with an unadjusted hazard ratio of 4.4 (95% CI 2.3-8.4; p<0.0001). A decrease in plasma NT-proBNP of 10 pg/ml during the first 2 years of intervention was associated with a 1% relative reduction in the primary endpoint (p<0.001). Despite polypharmacological treatment targeting cardiovascular disease, the mean plasma NT-proBNP level increased during follow-up. Conclusions/interpretation We conclude that high plasma NT-proBNP is a major risk marker for cardiovascular disease in patients with type 2 diabetes and microalbuminuria.
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Results from several randomized controlled trials revealed that more intensive treatment of risk factors in people with increased levels of natriuretic peptides reduces the risk for symptomatic heart failure, heart failure hospitalization, and newly diagnosed left ventricular dysfunction.
“Results from several randomized controlled trials revealed that more intensive treatment of risk factors in people with increased levels of natriuretic peptides reduces the risk for symptomatic heart failure, heart failure hospitalization, and newly diagnosed left ventricular dysfunction (222,227,228).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [228]
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Experimental — accuracy not yet measuredResults from several randomized controlled trials revealed that more intensive treatment of risk factors in people with increased levels of natriuretic peptides reduces the risk for symptomatic heart failure, heart failure hospitalization, and newly diagnosed left ventricular dysfunction.
“Results from several randomized controlled trials revealed that more intensive treatment of risk factors in people with increased levels of natriuretic peptides reduces the risk for symptomatic heart failure, heart failure hospitalization, and newly diagnosed left ventricular dysfunction (211,216,217).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [217]
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Stamler, J., Vaccaro, O., Neaton, J. D., Wentworth, D., & The Multiple Risk Factor Intervention Trial Research Group (1993) · Diabetes Care · doi:10.2337/diacare.16.2.434 · Cited by 4,063 · see citing works
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Effect of a multifactorial intervention on mortality in type 2 diabetes
Gæde, P., Lund-Andersen, H., Parving, H.-H., & Pedersen, O. (2008) · New England Journal of Medicine · doi:10.1056/nejmoa0706245 · Cited by 3,489 · see citing works
Self-citationHuelsmann, M., Neuhold, S., Resl, M., Strunk, G., Brath, H., Francesconi, C., Adlbrecht, C., Prager, R., Luger, A., Pacher, R., et al. (2013) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2013.05.069 · Cited by 385 · see citing works
10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025
American Diabetes Association Professional Practice Committee, ElSayed, N. A., McCoy, R. G., Aleppo, G., Balapattabi, K., Beverly, E. A., Briggs Early, K., Bruemmer, D., Das, S. R., Echouffo-Tcheugui, J. B., et al. (2025) · Diabetes Care · doi:10.2337/dc25-s010 · Cited by 339 · see citing works
10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026
American Diabetes Association Professional Practice Committee for Diabetes*, Bajaj, M., McCoy, R. G., Balapattabi, K., Bannuru, R. R., Bellini, N. J., Bennett, A. K., Beverly, E. A., Briggs Early, K., ChallaSivaKanaka, S., et al. (2026) · Diabetes Care · doi:10.2337/dc26-s010 · Cited by 107 · see citing works
Bertoni, A. G., Wagenknecht, L. E., Kitzman, D. W., Marcovina, S. M., Rushing, J. T., Espeland, M. A., & ; and Brain Natriuretic Peptide Subgroup of the Look AHEAD Research Group (2012) · Obesity · doi:10.1038/oby.2011.296 · Cited by 34 · see citing works
Cardiovascular biomarkers in clinical studies of type 2 diabetes
Baldassarre, M. P. A., Andersen, A., Consoli, A., Knop, F. K., & Vilsbøll, T. (2018) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.13247 · Cited by 22 · see citing works
- Authors
- G�de, P., Hildebrandt, P., Hess, G., Parving, H.-H., & Pedersen, O.
- Affiliations
- Frederiksberg Hospital (DK)
- F. Hoffmann-La Roche AG (CH)
- Steno Diabetes Centers (DK)
- ORCID
- Pedersen, O.
- Venue
- Diabetologia
- Published
- 2004-12-24
- Volume
- 48
- Issue
- 1
- Pages
- 156-163
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W1998083116
- Cited by
- 105
- References
- 1
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2 · 2023: 3 · 2022: 3 · 2021: 2 · 2020: 5 · 2019: 1 · 2018: 2 · 2017: 3 · 2016: 1 · 2015: 3 · 2014: 8 · 2013: 7 · 2012: 8
- FWCI
- 4.58
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- N-terminal pro-brain natriuretic peptide, NT-proBNP, type 2 diabetes, microalbuminuria, cardiovascular risk prediction, cardiovascular outcomes, multifactorial treatment, cardiovascular mortality, myocardial infarction, stroke, revascularization, amputation
- MeSH terms
- Albuminuria, Blood Pressure, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Female, Follow-Up Studies, Glycated Hemoglobin, Humans, Male, Middle Aged, Nerve Tissue Proteins, Peptide Fragments, Smoking, Time Factors, Cohort Studies, Biomarkers, Proportional Hazards Models, Natriuretic Peptide, Brain
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