TY - JOUR
T1 - Longitudinal assessment of N-terminal pro-B-type natriuretic peptide and risk of diabetes in older adults
T2 - The cardiovascular health study
AU - Brutsaert, Erika F.
AU - Biggs, Mary L.
AU - Delaney, Joseph A.
AU - Djoussé, Luc
AU - Gottdiener, John S.
AU - Ix, Joachim H.
AU - Kim, Francis
AU - Mukamal, Kenneth J.
AU - Siscovick, David S.
AU - Tracy, Russell P.
AU - de Boer, Ian H.
AU - deFilippi, Christopher R.
AU - Kizer, Jorge R.
N1 - Funding Information:
This work was supported by R01 HL-094555, as well as by contracts HHSN268201200036C, HHSN268200800007C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, and N01HC85086, and grant U01HL080295 from the National Heart, Lung, and Blood Institute (NHLBI), with additional contribution from the National Institute of Neurological Disorders and Stroke (NINDS). Additional support was provided by R01AG023629 from the National Institute on Aging (NIA). A full list of principal CHS investigators and institutions can be found at CHS-NHLBI.org .
Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Introduction Natriuretic peptides have a well-recognized role in cardiovascular homeostasis. Recently, higher levels of B-type natriuretic peptide (BNP) have also been associated with decreased risk of diabetes in middle-aged adults. Whether this association persists into older age, where the pathophysiology of diabetes changes, has not been established, nor has its intermediate pathways. Methods We investigated the relationship between N-terminal (NT)-proBNP and incident diabetes in 2359 older adults free of cardiovascular disease or chronic kidney disease in the Cardiovascular Health Study. Results We documented 348 incident cases of diabetes over 12.6 years of median follow-up. After adjusting for age, sex, race, body mass index, systolic blood pressure, anti-hypertensive treatment, smoking, alcohol use, and LDL, each doubling of NT-proBNP was associated with a 9% lower risk of incident diabetes (HR = 0.91 [95% CI: 0.84–0.99]). Additional adjustment for waist circumference, physical activity, estimated glomerular filtration rate or C-reactive protein did not influence the association. Among putative mediators, HDL and triglycerides, adiponectin, and especially homeostasis model assessment of insulin resistance, all appeared to account for a portion of the lower risk associated with NT-proBNP. Conclusion In older adults without prevalent cardiovascular or kidney disease, higher NT-proBNP is associated with decreased risk of incident diabetes even after adjustment for traditional risk factors. These findings suggest that the metabolic effects of natriuretic peptides persist late in life and offer a potential therapeutic target for prevention of diabetes in older people.
AB - Introduction Natriuretic peptides have a well-recognized role in cardiovascular homeostasis. Recently, higher levels of B-type natriuretic peptide (BNP) have also been associated with decreased risk of diabetes in middle-aged adults. Whether this association persists into older age, where the pathophysiology of diabetes changes, has not been established, nor has its intermediate pathways. Methods We investigated the relationship between N-terminal (NT)-proBNP and incident diabetes in 2359 older adults free of cardiovascular disease or chronic kidney disease in the Cardiovascular Health Study. Results We documented 348 incident cases of diabetes over 12.6 years of median follow-up. After adjusting for age, sex, race, body mass index, systolic blood pressure, anti-hypertensive treatment, smoking, alcohol use, and LDL, each doubling of NT-proBNP was associated with a 9% lower risk of incident diabetes (HR = 0.91 [95% CI: 0.84–0.99]). Additional adjustment for waist circumference, physical activity, estimated glomerular filtration rate or C-reactive protein did not influence the association. Among putative mediators, HDL and triglycerides, adiponectin, and especially homeostasis model assessment of insulin resistance, all appeared to account for a portion of the lower risk associated with NT-proBNP. Conclusion In older adults without prevalent cardiovascular or kidney disease, higher NT-proBNP is associated with decreased risk of incident diabetes even after adjustment for traditional risk factors. These findings suggest that the metabolic effects of natriuretic peptides persist late in life and offer a potential therapeutic target for prevention of diabetes in older people.
KW - BNP
KW - Diabetes
KW - Elders
KW - Natriuretic peptide
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U2 - 10.1016/j.metabol.2016.06.002
DO - 10.1016/j.metabol.2016.06.002
M3 - Article
C2 - 27621184
AN - SCOPUS:84980350911
SN - 0026-0495
VL - 65
SP - 1489
EP - 1497
JO - Metabolism: Clinical and Experimental
JF - Metabolism: Clinical and Experimental
IS - 10
ER -
