N-terminal probrain natriuretic peptide is a stronger predictor of cardiovascular mortality than C-reactive protein and albumin excretion rate in elderly patients with type 2 diabetes: the Casale Monferrato population-based study.
N-terminal probrain natriuretic peptide is a stronger predictor of cardiovascular mortality than C-reactive protein and albumin excretion rate in elderly patients with type 2 diabetes: the Casale Monferrato population-based study.
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DOI：
10.2337/dc13-0353
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发表时间：
2013-09
期刊：
影响因子：
16.2
通讯作者：
Gruden G
中科院分区：
文献类型：
--
作者：
Bruno G;Landi A;Barutta F;Ghezzo G;Baldin C;Spadafora L;Schimmenti A;Prinzis T;Cavallo Perin P;Gruden G
研究N-末端脑钠肽前体（NT-proBNP）是否是2型糖尿病患者全因死亡率和心血管（CV）死亡率的短期独立预测因子，并确定白蛋白尿和C-反应蛋白（CRP）是否影响这种关系。这项前瞻性研究包括来自Casale Monferrato研究人群队列的1，825名2型糖尿病患者。在基线时评价CV风险因素、既存CVD和NT-proBNP水平。在基线检查后5.5年评估全因和CV死亡率。多变量考克斯比例风险模型用于估计死亡风险比（HR）。在随访期间，在9,101人年的观察中，有390人死亡（175人死于CVD）。观察到NT-proBNP四分位数的死亡风险显著增加（趋势检验，P < 0.001）。NT-proBN P值>91 pg/mL时，所有原因的HR为2.05（95% CI 1.47-2.86），CV死亡率的HR为4.47（2.38-8.39），与CV风险因素（包括CRP和白蛋白排泄率（AER））无关。在基线时NT-proBNP水平中度升高和无微量白蛋白尿和CVD的患者中，这种相关性也具有显著性（上四分位数HR分别为3.82 [95% CI 1.24-13.75]和3.14 [1.00-9.94]）。白蛋白尿和NT-proBNP对死亡率有累加效应，尽管NT-proBNP的相关性更强。NT-proBNP是2型糖尿病老年患者（包括既往无CVD的患者）短期CV死亡风险的强独立预测因子。这种关联即使在数值略微升高的人群中也是明显的，不受CRP的影响，并且与AER提供的相关性相加。
To study whether N-terminal probrain natriuretic peptide (NT-proBNP) is a short-term independent predictor of both all-cause and cardiovascular (CV) mortality in type 2 diabetic patients and to establish whether albuminuria and C-reactive protein (CRP) affect this relationship. The prospective study included 1,825 type 2 diabetic patients from the population-based cohort of the Casale Monferrato study. CV risk factors, preexisting CVD, and NT-proBNP levels were evaluated at baseline. All-cause and CV mortality were assessed 5.5 years after baseline examination. Multivariate Cox proportional hazards modeling was used to estimate mortality hazard ratios (HRs). During the follow-up period, 390 people died (175 for CVD) out of 9,101 person-years of observations. A significantly increased mortality risk by quartiles of NT-proBNP was observed (test for trend, P < 0.001). NT-proBN P values >91 pg/mL conferred HRs of 2.05 (95% CI 1.47–2.86) for all-cause and 4.47 (2.38–8.39) for CV mortality, independently of CV risk factors, including CRP and albumin excretion rate (AER). The association was also significant for modest rises in NT-proBNP levels and in patients without microalbuminuria and CVD at baseline (upper quartiles HRs 3.82 [95% CI 1.24–13.75]) and 3.14 [1.00–9.94]). Albuminuria and NT-proBNP had an additive effect on mortality, though the association was stronger for NT-proBNP. NT-proBNP is a strong independent predictor of short-term CV mortality risk in elderly people with type 2 diabetes, including those without preexisting CVD. This association is evident even in people with slightly increased values, is not modified by CRP, and is additive to that provided by AER.
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