Plasma NT-proBNP and white matter hyperintensities in type 2 diabetic patients

Cardiovasc Diabetol. 2012 Oct 3:11:119. doi: 10.1186/1475-2840-11-119.

Abstract

Elevated plasma N-terminal (NT)-proBNP from the heart as well as white matter hyperintensities (WMH) in the brain predict cardiovascular (CV) mortality in the general population. The cause of poor prognosis associated with elevated P-NT-proBNP is not known but WMH precede strokes in high risk populations. We assessed the association between P-NT-proBNP and WMH or brain atrophy measured with magnetic resonance imaging (MRI) in type 2 diabetic patients, and age-matched controls.

Methods and results: We measured P-NT-proBNP(ng/l) in 20 diabetic patients without prior stroke but with(n=10) or without(n=10) asymptomatic coronary artery disease(CAD) in order to include patients with a wide-ranging CV risk profile. All patients and 26 controls had a 3D MRI and brain volumes(ml) with WMH and brain parenchymal fraction(BPF), an indicator of brain atrophy, were determined.P-NT-proBNP was associated with WMH in linear regression analysis adjusted for CV risk factors(r=0.94, p=0.001) and with BPF in univariate analysis(r=0.57, p=0.009). Patients divided into groups of increased P-NT-proBNP levels were paralleled with increased WMH volumes(geometric mean[SD];(2.86[5.11] ml and 0.76[2.49] ml compared to patients with low P-NT-proBNP 0.20[2.28] ml, p=0.003)) and also when adjusted for age, sex and presence of CAD(p=0.017). The association was strengthened by CV risk factors and we did not find a common heart or brain specific driver of both P-NT-proBNP and WMH. Patients and particular patients with CAD had higher WMH, however no longer after adjustment for age and sex.

Conclusion: P-NT-proBNP was associated with WMH in type 2 diabetic patients, suggesting a linkage between heart and brain disease.

MeSH terms

  • Adult
  • Aged
  • Atrophy
  • Biomarkers / blood
  • Brain / pathology*
  • Case-Control Studies
  • Chi-Square Distribution
  • Coronary Artery Disease / blood
  • Coronary Artery Disease / etiology*
  • Coronary Artery Disease / pathology
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / pathology
  • Female
  • Humans
  • Leukoencephalopathies / blood
  • Leukoencephalopathies / etiology*
  • Leukoencephalopathies / pathology
  • Linear Models
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Natriuretic Peptide, Brain / blood*
  • Organ Size
  • Peptide Fragments / blood*
  • Risk Assessment
  • Risk Factors
  • Up-Regulation

Substances

  • Biomarkers
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain