Screening Natriuretic Peptide Levels Predicts Heart Failure and Death in Individuals With Type 1 and Type 2 Diabetes Without Known Heart Failure

Abstract

Objective: Heart failure (HF) is common in diabetes and may be asymptomatic in early stages. N-terminal pro-brain natriuretic peptide (NT-proBNP) and B-type natriuretic peptide (BNP) (collectively natriuretic peptides [NPs]) are markers that can be used to detect early HF in asymptomatic individuals who may benefit from disease-modifying therapies. We examined the prognostic role of NP levels in people with type 1 diabetes (T1D) or type 2 diabetes (T2D) without known HF.

Research design and methods: Optum's de-identified Market Clarity Data were queried for adults (aged ≥18 years) with T1D or T2D without known HF who received an outpatient NP test between 2017 and 2023. Associations between NP levels and incident HF or death were assessed using multivariable Cox proportional hazard models.

Results: Among 116,466 eligible adults (n = 2,990 with T1D; n = 113,476 with T2D) followed for up to 7 years (54% female; median age 64 years; mean HbA1c 7.1% at baseline), approximately 39.6% of individuals with T1D and 42.3% of individuals with T2D had BNP ≥50 pg/mL or NT-proBNP ≥125 pg/mL. In adjusted Cox models, increased NT-proBNP level was significantly associated with increased risk of incident HF or mortality among individuals with T1D (for NT-proBNP level 125-300 pg/mL: HR [95% CI] 2.04 [1.35-3.07], for NT-proBNP level >300 pg/mL: 4.48 [3.11-6.47], reference: NT-proBNP <125 pg/mL) and T2D (for NT-proBNP level 125-300 pg/mL: HR [95% CI] 1.85 [1.74-1.97], for NT-proBNP >300 pg/mL: 3.58 [3.39-3.78], reference: NT-proBNP <125 pg/mL). Similar findings were observed for BNP.

Conclusions: Increased NP levels among individuals with diabetes are highly prognostic for future risk of HF or mortality. These findings support the implementation of NP screening for HF risk assessment in people with diabetes.