From the Guidelines
Natriuretic peptide assessment is a crucial tool in identifying heart failure risk in diabetic patients, and its measurement is recommended in diabetic patients with symptoms suggestive of heart failure or those with multiple cardiovascular risk factors.
Key Points to Consider
- The measurement of natriuretic peptides, including B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP), identifies people at risk for heart failure development, progression of symptoms, and heart failure–related mortality 1.
- Diabetic patients are at particularly high risk for progression from asymptomatic stage A and B to symptomatic stage C and D heart failure, making early detection crucial 1.
- Elevated levels of natriuretic peptides (BNP >100 pg/mL or NT-proBNP >125 pg/mL) warrant further cardiac evaluation, including echocardiography 1.
- Regular monitoring of natriuretic peptides in high-risk diabetic patients can facilitate timely intervention with appropriate medications (ACE inhibitors, ARBs, SGLT2 inhibitors) and lifestyle modifications to prevent heart failure progression 1.
- The test is minimally invasive, requiring only a blood sample, and provides valuable prognostic information beyond traditional risk factors 1.
Clinical Implications
- The use of natriuretic peptide assessment in diabetic patients can lead to early detection and treatment of heart failure, reducing the risk of progression to symptomatic heart failure and improving patient outcomes.
- The results from several randomized controlled trials, such as the NT-proBNP Guided Primary Prevention of CV Events in Diabetic Patients (PONTIAC) trial and the St Vincent’s Screening to Prevent Heart Failure Study (STOP-HF), support the use of natriuretic peptide assessment in diabetic patients to reduce the risk of symptomatic heart failure and heart failure-related mortality 1.
- The American Diabetes Association recommends the measurement of natriuretic peptides in diabetic patients as part of a comprehensive approach to cardiovascular risk management 1.
From the Research
Natriuretic Peptide Assessment in Diabetic Patients
- Natriuretic peptides, such as B-type natriuretic peptide (BNP) and N-terminal-proBNP (NT-proBNP), play a crucial role in identifying diabetic patients at risk for heart failure development, progression of symptoms, and heart failure-related mortality 2, 3, 4.
- Elevated levels of natriuretic peptides correlate with cardiac structural and functional abnormalities, aiding in risk stratification and treatment strategies in individuals with diabetes 2, 4.
- The use of natriuretic peptides as biomarkers for detecting heart disease and assessing cardiovascular risk in asymptomatic patients with diabetes has been recognized 3, 5.
Role of Natriuretic Peptides in Risk Assessment
- Natriuretic peptides have a high negative predictive value, and low levels can safely exclude a diagnosis of heart failure in both emergency and outpatient settings 4, 6.
- Threshold values for natriuretic peptides, such as BNP < 100 pg/mL and NT-proBNP < 300 pg/mL, are associated with increased risks of major cardiovascular events, cardiovascular mortality, and all-cause mortality 4.
- Natriuretic peptide-based screening and targeted prevention can reduce heart failure and left ventricular dysfunction and other major cardiovascular events in diabetic patients 5.
Clinical Considerations and Recommendations
- The American Diabetes Association (ADA) recommends the use of natriuretic peptides for risk assessment in diabetic patients 3.
- A consensus report by Portuguese medical societies advises the use of NT-proBNP analysis for all patients with diabetes aged 50 years and older, or under 50 if they have risk factors and/or comorbidities 3.
- Routine evaluation every two to three years for low-risk patients and annually for high-risk patients is proposed when NT-proBNP is below 125 pg/mL and in the absence of suspected heart disease 3.