NT-proBNP: Can We Better Utilize Biomarkers in Patients With Diabetes?

B-type natriuretic peptide (BNP) is secreted from the atria of the heart as a response to myocardial stretch that occurs with increases in volume, afterload, and other hemodynamic changes that result in increased cardiovascular stress. The atria of the heart secrete BNP in its proform and it is subsequently cleaved into an inactive form (N-terminal [NT]-proBNP) and an active form (BNP) (1). Although there are some differences with regard to interpretation of the assays for these different metabolites, both NT-proBNP and BNP (referred to collectively as natriuretic peptides [NP]) can be measured and quantified and play an important role in the diagnosis and management of both acute and chronic heart failure. While the role of NP in the management of heart failure is well established, the role of NP outside of heart failure is less well defined. Prior studies consistently show a clear relationship between elevated levels of NP and subsequent risk of cardiovascular events, including atrial fibrillation (2), diastolic dysfunction (3), coronary heart disease, and stroke (4), and the development of diabetes (5). Given these associations, it is possible to use NP to assist in the risk stratification of patients into those who are at high and low risk of cardiovascular events in populations at risk for cardiovascular disease, with stable coronary artery disease, or following a myocardial infarction (6). Furthermore, it is possible that these biomarkers could also help to tailor therapy such that patients at high risk have intensification of …