PONTIAC (NT-proBNP Selected PreventiOn of cardiac eveNts in a populaTion of dIabetic patients without A history of Cardiac disease)
Open accessAbstract
Objectives The study sought to assess the primary preventive effect of neurohumoral therapy in high-risk diabetic patients selected by N-terminal pro-B-type natriuretic peptide (NT-proBNP). Background Few clinical trials have successfully demonstrated the prevention of cardiac events in patients with diabetes. One reason for this might be an inaccurate selection of patients. NT-proBNP has not been assessed in this context. Methods A total of 300 patients with type 2 diabetes, elevated NT-proBNP (>125 pg/ml) but free of cardiac disease were randomized. The "control" group was cared for at 4 diabetes care units; the "intensified" group was additionally treated at a cardiac outpatient clinic for the up-titration of renin-angiotensin system (RAS) antagonists and beta-blockers. The primary endpoint was hospitalization/death due to cardiac disease after 2 years. Results At baseline, the mean age of the patients was 67.5 ± 9 years, duration of diabetes was 15 ± 12 years, 37% were male, HbA1c was 7 ± 1.1%, blood pressure was 151 ± 22 mm Hg, heart rate was 72 ± 11 beats/min, median NT-proBNP was 265.5 pg/ml (interquartile range: 180.8 to 401.8 pg/ml). After 12 months there was a significant difference between the number of patients treated with a RAS antagonist/beta-blocker and the dosage reached between groups (p < 0.0001). Blood pressure was significantly reduced in both (p < 0.05); heart rate was only reduced in the intensified group (p = 0.004). A significant reduction of the primary endpoint (hazard ratio: 0.351; 95% confidence interval: 0.127 to 0.975, p = 0.044) was visible in the intensified group. The same was true for other endpoints: all-cause hospitalization, unplanned cardiovascular hospitalizations/death (p < 0.05 for all). Conclusions Accelerated up-titration of RAS antagonists and beta-blockers to maximum tolerated dosages is an effective and safe intervention for the primary prevention of cardiac events for diabetic patients pre-selected using NT-proBNP. (Nt-proBNP Guided Primary Prevention of CV Events in Diabetic Patients [PONTIAC]; NCT00562952).
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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 [222]
The Study design and hospitalization tables (pp. 1365–72; precise page unavailable in our copy) describe a randomized trial in patients with type 2 diabetes and elevated NT-proBNP. They report fewer heart-failure hospitalizations with intensified treatment (1 versus 7), although the reported time-to-event comparison was not statistically significant (p=0.07). The paper does not report symptomatic heart failure or newly diagnosed left ventricular dysfunction as outcomes; it also represents one trial, not evidence of results from several trials by itself. (LLM, conf=0.87)
Experimental — accuracy not yet measuredIdentification, risk stratification, and early treatment of risk factors in people with diabetes and asymptomatic stages of heart failure reduce the risk for progression to symptomatic heart failure.
“Identification, risk stratification, and early treatment of risk factors in people with diabetes and asymptomatic stages of heart failure reduce the risk for progression to symptomatic heart failure (221,222).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [222]
The Abstract reports fewer cardiac events after NT-proBNP-guided treatment in patients with type 2 diabetes who were free of cardiac disease. The Conclusions table also shows fewer heart-failure hospitalizations in the intensified group (1 versus 7), but the study did not establish that participants had asymptomatic heart failure or directly measure progression to symptomatic heart failure. The claim extends the findings beyond the population and outcome studied. (LLM, conf=0.86)
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 [211]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredIdentification, risk stratification, and early treatment of risk factors in people with diabetes and asymptomatic stages of heart failure reduce the risk for progression to symptomatic heart failure.
“Identification, risk stratification, and early treatment of risk factors in people with diabetes and asymptomatic stages of heart failure reduce the risk for progression to symptomatic heart failure (210,211).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [211]
The Abstract describes NT-proBNP risk selection and intensified treatment in people with type 2 diabetes who were free of cardiac disease, and reports fewer cardiac hospitalizations or deaths. The Conclusions table also shows fewer heart-failure hospitalizations (1 versus 7), but the Cox-model estimate for that endpoint was not statistically significant (p = 0.07). The paper did not establish that participants had asymptomatic-stage heart failure or directly measure progression to symptomatic heart failure. (LLM, conf=0.86)
Experimental — accuracy not yet measured
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- Authors
- Huelsmann, M., Neuhold, S., Resl, M., Strunk, G., Brath, H., Francesconi, C., Adlbrecht, C., Prager, R., Luger, A., Pacher, R., & Clodi, M.
- Affiliations
- Medical University of Vienna (AT)
- TU Dortmund University (DE)
- Klinik Hietzing (AT)
- Corresponding author
- Pacher, Richard
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2013-10
- Volume
- 62
- Issue
- 15
- Pages
- 1365-1372
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2113538868
- Cited by
- 385
- References
- 29
- Citations by year
- 2026: 43 · 2025: 41 · 2024: 43 · 2023: 34 · 2022: 39 · 2021: 30 · 2020: 28 · 2019: 22 · 2018: 24 · 2017: 26 · 2016: 26 · 2015: 14 · 2014: 11 · 2013: 3
- FWCI
- 12.25
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Universität Wien
- Medizinische Universität Wien
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Keywords
- NT-proBNP, type 2 diabetes, renin-angiotensin system inhibitors, beta-blockers, cardiovascular hospitalization, cardiovascular mortality, heart rate reduction, blood pressure reduction, cardiovascular risk stratification, all-cause hospitalization
- MeSH terms
- Aged, Angiotensin-Converting Enzyme Inhibitors, Blood Pressure, Diabetes Mellitus, Type 2, Female, Heart Diseases, Heart Rate, Hospitalization, Humans, Male, Peptide Fragments, Primary Prevention, Prospective Studies, Biomarkers, Natriuretic Peptide, Brain, Kaplan-Meier Estimate, Angiotensin Receptor Antagonists
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