Key result
Higher MR-proANP linked to increased MACE and mortality in type 1 diabetes.
Why the study?
Individuals with type 1 diabetes are at increased cardiovascular risk, and the associations of the cardiovascular stress biomarkers MR-proANP and copeptin with MACEs and all-cause mortality in this population versus controls required investigation.
Do MR-proANP and copeptin levels predict major adverse cardiovascular events and all-cause mortality in individuals with type 1 diabetes compared to controls?
Cohort (n=1,089)
Do MR-proANP and copeptin levels predict major adverse cardiovascular events and all-cause mortality in individuals with type 1 diabetes compared to controls?
MR-proANP, unlike copeptin, is an independent predictor of long-term major adverse cardiovascular events and all-cause mortality in individuals with type 1 diabetes.
Answers are grounded in this paper and cite their sources.
May inform risk stratification in type 1 diabetes; hypothesis-generating and should not yet change practice.
Background/Objectives: MR-proANP and copeptin are biomarkers of cardiovascular stress and individuals with type 1 diabetes are at increased cardiovascular risk. We aimed to investigate the associations of MR-proANP and copeptin with major adverse cardiovascular events (MACEs) and all-cause mortality in individuals with type 1 diabetes and in controls. Methods: MR-proANP and copeptin were measured in 576 individuals with type 1 diabetes and 513 controls enrolled in the LeDIG cohort. Participants were followed for a median of 10.7 and 10.2 years, respectively. Major adverse cardiovascular events (MACEs) and all-cause mortality were ascertained through linkage to the national Cause of Death and Inpatient Registries. Associations with outcomes were evaluated using Cox proportional hazards regression with adjustment for established cardiovascular risk factors. Non-linear associations were assessed using restricted cubic splines, and Kaplan–Meier analyses were performed across tertiles of MR-proANP. Results: In type 1 diabetes, higher MR-proANP levels were independently associated with increased risk of both MACE (HR 1.005, 95% CI 1.001–1.009; p = 0.010) and all-cause mortality (HR 1.008, 95% CI 1.003–1.012; p < 0.001) after multivariable adjustment. Individuals with type 1 diabetes had higher risks of MACE (HR 2.22, 95% CI 1.41–3.50; p < 0.001) and all-cause mortality (HR 4.36, 95% CI 2.13–8.90; p < 0.001) compared with controls. The association with MACE was attenuated and became statistically nonsignificant after additional adjustment for previous myocardial infarction or stroke (p = 0.086), but remained significant after exclusion of such individuals. Copeptin was not independently associated with outcomes after adjustment. In controls, MR-proANP was associated with mortality but not MACE. Conclusions: MR-proANP was independently associated with long-term risk of cardiovascular events and all-cause mortality in individuals with type 1 diabetes. MR-proANP may reflect established cardiovascular disease but also be associated with future cardiovascular risk in individuals without previous events. In contrast, copeptin was not independently associated with these outcomes.
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Gauffin et al. (2026) conducted a cohort in Type 1 diabetes (n=1,089). MR-proANP and copeptin levels vs. Lower biomarker levels / non-diabetic controls was evaluated on Major adverse cardiovascular events (MACEs) (HR 1.005, 95% CI 1.001-1.009, p=0.010). Higher MR-proANP levels in type 1 diabetes were independently associated with increased MACE (HR 1.005; 95% CI 1.001-1.009) and mortality (HR 1.008; 95% CI 1.003-1.012), whereas copeptin was not.
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