NT-proBNP and cardiovascular event risk in individuals with prediabetes undergoing cardiovascular evaluation

Aims: Cardiovascular risk assessment beyond traditional risk factors in subjects with prediabetes is not well-established. Here, we evaluated the utility of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in predicting incident adverse cardiovascular outcomes in prediabetic subjects. Methods: NT-proBNP was analyzed in 3,235 stable subjects with prediabetes undergoing cardiovascular risk evaluation and followed for both 3-year major adverse cardiac events (MACE; death, myocardial infarction, stroke), and 5-year all-cause mortality. Results: Using Cox proportional hazard models, we found that plasma NT-proBNP was associated with incident (3–year) MACE risk (Q4 vs Q1, HR 6.04 [95%CI 4.17–8.76], P < 0.001) and 5-year mortality risk (HR 8.64 [95%CI 5.78–12.9], P < 0.001). These associations remained significant after adjustments for traditional cardiovascular risk factors, multiple indices of glycemic control, cardiovascular disease (CVD), left ventricular ejection fraction (LVEF), and medication (e.g. diuretic) use (adjusted HR for 3-year MACE 2.65 [95% CI 1.16–6.05], P < 0.05; and adjusted HR for 5-year mortality 3.45 [95% CI 1.42–8.39], P < 0.01). NT-proBNP significantly improved the clinical prognostic value (C-statistic, NRI, IDI) for both 3-year MACE and 5-year death when added to models. Conclusions: NT-proBNP independently predicts increased long-term MACE and mortality risks in prediabetic subjects, and may help identify those for whom more aggressive global preventive efforts are indicated.