Cargando…
NT-proBNP levels, atherosclerosis and vascular function in asymptomatic type 2 diabetic patients with microalbuminuria: peripheral reactive hyperaemia index but not NT-proBNP is an independent predictor of coronary atherosclerosis
Intensive multifactorial treatment aimed at cardiovascular (CV) risk factor reduction in type 2 diabetic patients with microalbuminuria can diminish fatal and non-fatal CV. Plasma N-terminal (NT)-proBNP predicts CV mortality in diabetic patients but the utility of P-NT-proBNP in screening for athero...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2011
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3164620/ https://www.ncbi.nlm.nih.gov/pubmed/21812947 http://dx.doi.org/10.1186/1475-2840-10-71 |
_version_ | 1782211055817064448 |
---|---|
author | Reinhard, Henrik Wiinberg, Niels Hansen, Peter R Kjær, Andreas Petersen, Claus L Winther, Kaj Parving, Hans-Henrik Rossing, Peter Jacobsen, Peter K |
author_facet | Reinhard, Henrik Wiinberg, Niels Hansen, Peter R Kjær, Andreas Petersen, Claus L Winther, Kaj Parving, Hans-Henrik Rossing, Peter Jacobsen, Peter K |
author_sort | Reinhard, Henrik |
collection | PubMed |
description | Intensive multifactorial treatment aimed at cardiovascular (CV) risk factor reduction in type 2 diabetic patients with microalbuminuria can diminish fatal and non-fatal CV. Plasma N-terminal (NT)-proBNP predicts CV mortality in diabetic patients but the utility of P-NT-proBNP in screening for atherosclerosis is unclear. We examined the interrelationship between P-NT-proBNP, presence of atherosclerosis and/or vascular dysfunction in the coronary, carotid and peripheral arteries in asymptomatic type 2 diabetic patients with microalbuminuria that received intensive multifactorial treatment. METHODS AND RESULTS: P-NT-proBNP was measured in 200 asymptomatic type 2 patients without known cardiac disease that received intensive multifactorial treatment for CV risk reduction. Patients were examined for coronary, carotid and peripheral atherosclerosis, as defined by coronary calcium score ≥400, carotid intima-media thickness (CIMT) > 0.90 mm, ankle-brachial index < 0.90, and/or toe-brachial index < 0.64, respectively. Carotid artery compliance was also determined and the reactive hyperaemia index (RHI) measured by peripheral artery tonometry was used as a surrogate for endothelial function. P-NT-proBNP was associated with atherosclerosis in the unadjusted analysis, but not after adjustment for conventional risk factors. P-NT-proBNP was not associated with vascular dysfunction. The prevalence of atherosclerosis in the coronary, carotid and peripheral arteries was 35%, 10% and 21% of all patients, respectively. In total 49% had atherosclerosis in one territory and 15.6% and 1.0% in two and three territories. Low RHI was an independent predictor of coronary atherosclerosis (odds ratio [CI], 2.60 [1.15-5.88] and systolic blood pressure was the only independent determinant of CIMT (0.02 mm increase in CIMT per 10 mmHg increase in systolic blood pressure [p = 0.003]). CONCLUSIONS: Half of asymptomatic patients with type 2 diabetes mellitus and microalbuminuria had significant atherosclerosis in at least one vascular territory despite receiving intensive multifactorial treatment for CV risk reduction. Coronary atherosclerosis was most prevalent, whereas carotid disease was more rarely observed. RHI but not plasma NT-proBNP was predictive of coronary atherosclerosis. |
format | Online Article Text |
id | pubmed-3164620 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2011 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-31646202011-09-02 NT-proBNP levels, atherosclerosis and vascular function in asymptomatic type 2 diabetic patients with microalbuminuria: peripheral reactive hyperaemia index but not NT-proBNP is an independent predictor of coronary atherosclerosis Reinhard, Henrik Wiinberg, Niels Hansen, Peter R Kjær, Andreas Petersen, Claus L Winther, Kaj Parving, Hans-Henrik Rossing, Peter Jacobsen, Peter K Cardiovasc Diabetol Original Investigation Intensive multifactorial treatment aimed at cardiovascular (CV) risk factor reduction in type 2 diabetic patients with microalbuminuria can diminish fatal and non-fatal CV. Plasma N-terminal (NT)-proBNP predicts CV mortality in diabetic patients but the utility of P-NT-proBNP in screening for atherosclerosis is unclear. We examined the interrelationship between P-NT-proBNP, presence of atherosclerosis and/or vascular dysfunction in the coronary, carotid and peripheral arteries in asymptomatic type 2 diabetic patients with microalbuminuria that received intensive multifactorial treatment. METHODS AND RESULTS: P-NT-proBNP was measured in 200 asymptomatic type 2 patients without known cardiac disease that received intensive multifactorial treatment for CV risk reduction. Patients were examined for coronary, carotid and peripheral atherosclerosis, as defined by coronary calcium score ≥400, carotid intima-media thickness (CIMT) > 0.90 mm, ankle-brachial index < 0.90, and/or toe-brachial index < 0.64, respectively. Carotid artery compliance was also determined and the reactive hyperaemia index (RHI) measured by peripheral artery tonometry was used as a surrogate for endothelial function. P-NT-proBNP was associated with atherosclerosis in the unadjusted analysis, but not after adjustment for conventional risk factors. P-NT-proBNP was not associated with vascular dysfunction. The prevalence of atherosclerosis in the coronary, carotid and peripheral arteries was 35%, 10% and 21% of all patients, respectively. In total 49% had atherosclerosis in one territory and 15.6% and 1.0% in two and three territories. Low RHI was an independent predictor of coronary atherosclerosis (odds ratio [CI], 2.60 [1.15-5.88] and systolic blood pressure was the only independent determinant of CIMT (0.02 mm increase in CIMT per 10 mmHg increase in systolic blood pressure [p = 0.003]). CONCLUSIONS: Half of asymptomatic patients with type 2 diabetes mellitus and microalbuminuria had significant atherosclerosis in at least one vascular territory despite receiving intensive multifactorial treatment for CV risk reduction. Coronary atherosclerosis was most prevalent, whereas carotid disease was more rarely observed. RHI but not plasma NT-proBNP was predictive of coronary atherosclerosis. BioMed Central 2011-08-03 /pmc/articles/PMC3164620/ /pubmed/21812947 http://dx.doi.org/10.1186/1475-2840-10-71 Text en Copyright ©2011 Reinhard et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Investigation Reinhard, Henrik Wiinberg, Niels Hansen, Peter R Kjær, Andreas Petersen, Claus L Winther, Kaj Parving, Hans-Henrik Rossing, Peter Jacobsen, Peter K NT-proBNP levels, atherosclerosis and vascular function in asymptomatic type 2 diabetic patients with microalbuminuria: peripheral reactive hyperaemia index but not NT-proBNP is an independent predictor of coronary atherosclerosis |
title | NT-proBNP levels, atherosclerosis and vascular function in asymptomatic type 2 diabetic patients with microalbuminuria: peripheral reactive hyperaemia index but not NT-proBNP is an independent predictor of coronary atherosclerosis |
title_full | NT-proBNP levels, atherosclerosis and vascular function in asymptomatic type 2 diabetic patients with microalbuminuria: peripheral reactive hyperaemia index but not NT-proBNP is an independent predictor of coronary atherosclerosis |
title_fullStr | NT-proBNP levels, atherosclerosis and vascular function in asymptomatic type 2 diabetic patients with microalbuminuria: peripheral reactive hyperaemia index but not NT-proBNP is an independent predictor of coronary atherosclerosis |
title_full_unstemmed | NT-proBNP levels, atherosclerosis and vascular function in asymptomatic type 2 diabetic patients with microalbuminuria: peripheral reactive hyperaemia index but not NT-proBNP is an independent predictor of coronary atherosclerosis |
title_short | NT-proBNP levels, atherosclerosis and vascular function in asymptomatic type 2 diabetic patients with microalbuminuria: peripheral reactive hyperaemia index but not NT-proBNP is an independent predictor of coronary atherosclerosis |
title_sort | nt-probnp levels, atherosclerosis and vascular function in asymptomatic type 2 diabetic patients with microalbuminuria: peripheral reactive hyperaemia index but not nt-probnp is an independent predictor of coronary atherosclerosis |
topic | Original Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3164620/ https://www.ncbi.nlm.nih.gov/pubmed/21812947 http://dx.doi.org/10.1186/1475-2840-10-71 |
work_keys_str_mv | AT reinhardhenrik ntprobnplevelsatherosclerosisandvascularfunctioninasymptomatictype2diabeticpatientswithmicroalbuminuriaperipheralreactivehyperaemiaindexbutnotntprobnpisanindependentpredictorofcoronaryatherosclerosis AT wiinbergniels ntprobnplevelsatherosclerosisandvascularfunctioninasymptomatictype2diabeticpatientswithmicroalbuminuriaperipheralreactivehyperaemiaindexbutnotntprobnpisanindependentpredictorofcoronaryatherosclerosis AT hansenpeterr ntprobnplevelsatherosclerosisandvascularfunctioninasymptomatictype2diabeticpatientswithmicroalbuminuriaperipheralreactivehyperaemiaindexbutnotntprobnpisanindependentpredictorofcoronaryatherosclerosis AT kjærandreas ntprobnplevelsatherosclerosisandvascularfunctioninasymptomatictype2diabeticpatientswithmicroalbuminuriaperipheralreactivehyperaemiaindexbutnotntprobnpisanindependentpredictorofcoronaryatherosclerosis AT petersenclausl ntprobnplevelsatherosclerosisandvascularfunctioninasymptomatictype2diabeticpatientswithmicroalbuminuriaperipheralreactivehyperaemiaindexbutnotntprobnpisanindependentpredictorofcoronaryatherosclerosis AT wintherkaj ntprobnplevelsatherosclerosisandvascularfunctioninasymptomatictype2diabeticpatientswithmicroalbuminuriaperipheralreactivehyperaemiaindexbutnotntprobnpisanindependentpredictorofcoronaryatherosclerosis AT parvinghanshenrik ntprobnplevelsatherosclerosisandvascularfunctioninasymptomatictype2diabeticpatientswithmicroalbuminuriaperipheralreactivehyperaemiaindexbutnotntprobnpisanindependentpredictorofcoronaryatherosclerosis AT rossingpeter ntprobnplevelsatherosclerosisandvascularfunctioninasymptomatictype2diabeticpatientswithmicroalbuminuriaperipheralreactivehyperaemiaindexbutnotntprobnpisanindependentpredictorofcoronaryatherosclerosis AT jacobsenpeterk ntprobnplevelsatherosclerosisandvascularfunctioninasymptomatictype2diabeticpatientswithmicroalbuminuriaperipheralreactivehyperaemiaindexbutnotntprobnpisanindependentpredictorofcoronaryatherosclerosis |