Additive prognostic value of plasma N-terminal pro-brain natriuretic peptide and coronary artery calcification for cardiovascular events and mortality in asymptomatic patients with type 2 diabetes
Additive prognostic value of plasma N-terminal pro-brain natriuretic peptide and coronary artery calcification for cardiovascular events and mortality in asymptomatic patients with type 2 diabetes
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DOI：
10.1186/s12933-015-0225-0
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发表时间：
2015-05-21
影响因子：
9.3
通讯作者：
Rossing, Peter
中科院分区：
文献类型：
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作者：
von Scholten, Bernt Johan;Reinhard, Henrik;Rossing, Peter
背景：在2型糖尿病患者中，心血管疾病（CVD）是发病率和死亡率的主要原因。我们评估了NT-proBNP和冠状动脉钙评分（CAC）联合预测2型糖尿病和微量白蛋白尿患者（>30 mg/24小时）合并致死性和非致死性CVD和死亡率，但没有已知的冠状动脉疾病。此外，我们评估了在基线时将患者预先分类为高风险组和低风险组的预测价值。方法：前瞻性研究，纳入200例患者。所有患者均接受多因素强化治疗。基线NT-proBNP >45.2 ng/L和/或CAC >= 400的患者被分层为高危患者（n = 133）。6.1年后（中位数）追踪致命性和非致命性CVD （n = 40）和死亡率（n = 26）的发生情况。结果：高危患者发生复合心血管疾病终点的风险较高(校正危险比[HR] 10.6(95%可信区间[CI] 2.4-46.3)；p = 0.002)和死亡率(校正后HR 5.3 (95% CI 1.2-24.0)；P = 0.032)。在调整后的连续分析中，较高的NT-proBNP和CAC是复合心血管疾病终点和死亡率的强预测因子
Background: In patients with type 2 diabetes, cardiovascular disease (CVD) is the major cause of morbidity and mortality. We evaluated the combination of NT-proBNP and coronary artery calcium score (CAC) for prediction of combined fatal and non-fatal CVD and mortality in patients with type 2 diabetes and microalbuminuria (>30 mg/24-h), but without known coronary artery disease. Moreover, we assessed the predictive value of a predefined categorisation of patients into a high-and low-risk group at baseline.Methods: Prospective study including 200 patients. All received intensive multifactorial treatment. Patients with baseline NT-proBNP >45.2 ng/L and/or CAC >= 400 were stratified as high-risk patients (n = 133). Occurrence of fatal-and nonfatal CVD (n = 40) and mortality (n = 26), was traced after 6.1 years (median).Results: High-risk patients had a higher risk of the composite CVD endpoint (adjusted hazard ratio [HR] 10.6 (95 % confidence interval [CI] 2.4-46.3); p = 0.002) and mortality (adjusted HR 5.3 (95 % CI 1.2-24.0); p = 0.032) compared to low-risk patients. In adjusted continuous analysis, both higher NT-proBNP and CAC were strong predictors of the composite CVD endpoint and mortality (p