Increased natriuretic peptides levels help predict future risk of HF or mortality among diabetes patients: Study

A new study published in the journal of Diabetes Care showed that even in persons with type 1 diabetes (T1D) or type 2 diabetes (T2D) who do not currently have heart failure (HF), natriuretic peptides may be an effective predictor of future HF and mortality.

Natriuretic peptides, like N-terminal pro-brain natriuretic peptide (NT-proBNP) and B-type natriuretic peptide (BNP), are effective biomarkers for diagnosing and monitoring heart failure. Emerging data shows that its application may expand beyond symptomatic patients, providing predictive insights in people without established heart failure. Recent research has found that even minor increases in natriuretic peptide levels are strongly connected with an increased risk of developing heart failure or death in these groups.

This demonstrates the potential value of regular natriuretic peptide screening as a predictive tool, allowing for early risk categorization and perhaps enhancing clinical outcomes in diabetes therapy. Thus, this study looked at the predictive effect of NP levels in persons with type 1 diabetes or type 2 diabetes but no known heart failure (HF).

In this study, for persons (aged ≥18) with T1D or T2D without known HF who underwent an outpatient NP test between 2017 and 2023, Optum's de-identified Market Clarity Data were queried. Multivariable Cox proportional hazard models were used to evaluate associations between NP levels and incident HF or mortality.

Approximately 39.6% of T1D patients and 42.3% of T2D patients had BNP ≥50 pg/mL or NT-proBNP ≥125 pg/mL among 116,466 eligible people (n = 2,990 with T1D and n = 113,476 with T2D) followed for up to 7 years (54% female; median age 64 years; mean HbA1c 7.1% at baseline). In adjusted Cox regression models, greater NT-proBNP levels were substantially associated with an increased risk of developing heart failure or mortality in both type 1 and type 2 diabetes patients.

Individuals with T1D had hazard ratios (HRs) of 2.04 and 4.48 for NT-proBNP levels between 125-300 pg/mL and >300 pg/mL, respectively, when compared to values below 125 pg/mL. Similarly, in T2D, NT-proBNP levels between 125 and 300 pg/mL were associated with HRs of 1.85 and 3.58, respectively. Similar relationships were observed with BNP levels.

Overall, increased NP levels in diabetic patients are substantially predictive of eventual HF or death. These findings support the use of NP screening for HF risk assessment in diabetics.

Reference:

Pop-Busui, R., Repetto, E., Baron, J., Schumacher, D., Vaduganathan, M., & Pandey, A. (2025). Screening natriuretic peptide levels predicts heart failure and death in individuals with type 1 and type 2 diabetes without known heart failure. Diabetes Care, dc251260. https://doi.org/10.2337/dc25-1260