Levels of brain natriuretic peptide are associated with peripheral arterial disease in subjects with type-2 diabetes mellitus

BMC Endocrine Disorders

Chun-mao Han²  Lei Xu³  Liang Zhong³  Qiang Liu³  Tian-lang Li³  Xiao-jun He¹  Huai-hong Chen³  Wan-lan Ye⁴  Qi-hui Jin³ 

[1] Emergency Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 JieFang Rd, Hangzhou, Zhejiang 310009, China;Department of Burn, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 JieFang Rd, Hangzhou, Zhejiang 310009, China;Geriatric Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 JieFang Rd, Hangzhou, Zhejiang 310009, China;Endocrinology, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 JieFang Rd, Hangzhou, Zhejiang 310009, China

关键词: Type-2 diabetes mellitus;    Peripheral arterial disease;    Brain natriuretic peptide;   

Others  :  864941
DOI  :  10.1186/1472-6823-14-27

 received in 2013-12-12, accepted in 2014-03-17,  发布年份 2014

【 摘 要 】

Background

The effects of brain natriuretic peptide (BNP) on the risk of cardiovascular disease and atherosclerosis have been studied. However, little information is available regarding peripheral arterial disease (PAD), particularly among subjects with type-2 diabetes mellitus (T2DM). The aim of our study was to assess the potential relationship between BNP levels and PAD among T2DM patients.

Methods

The study cohort was 507 T2DM outpatients in which BNP levels were measured. Cross-sectional associations between BNP levels (in tertiles) and PAD were examined.

Results

Compared withT2DM patients without PAD, BNP levels were markedly higher in patients with PAD (p = 0.001). Correlation analyses showed that the BNP level was negatively correlated with the ankle–brachial index (r = −0.453, p = 0.033). At a cutoff value of 78.2 pg/ml, the BNP level showed a sensitivity of 71.9%, a specificity of 68.1%, and a positive predictive value of 84.3% for a diagnosis of PAD. The area under the receiver-operating characteristic curve increased significantly if BNP levels were incorporated into a predictive model of the potential risk factors for PAD (0.85 vs 0.81, p = 0.029).

Conclusions

BNP is a potential and promising biomarker for PAD screening in T2DM patients.

【 授权许可】

   
2014 Jin et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]American Diabetes Association: Peripheral arterial disease in people with diabetes. Diabetes Care 2003, 26:3333-3341.
• [2]Wattanakit K, Folsom AR, Selvi NE, Weatherley BD, Pankow JS, Brancati FL, Hirsch AT: Risk factors for peripheral arterial disease incidence in persons with diabetes: The Athe rosclerosis Risk in Communities (ARIC) Study. Atherosclerosis 2005, 180:389-397.
• [3]Walters DP, Gatling W, Mullee MA, Hill RD: The prevalence, detection, and epidemiological correlates of peripheral vascular disease: a comparison of diabetic and non-diabetic subjects in an English community. Diabet Med 1992, 9:710-715.
• [4]Wannamethee SG, Welsh P, Lowe GD, Gudnason V, Di Angelantonio E, Lennon L, Rumley A, Whincup PH, Sattar N: N-terminal pro-brain natriuretic Peptide is a more useful predictor of cardiovascular disease risk than C-reactive protein in older men with and without pre-existing cardiovascular disease. J Am Coll Cardiol 2011, 58:56-64.
• [5]Ashley KE, Galla JM, Nicholls SJ: Brain natriuretic peptides as biomarkers for atherosclerosis. Prev Cardiol 2008, 11:172-176.
• [6]Svensson P, de Faire U, Niklasson U, Hansson LO, Ostergren J: Plasma NT-pro-BNP concentration is related to ambulatory pulse pressure in peripheral arterial disease. Blood Press 2005, 14:99-106.
• [7]Dieplinger B, Poelz W, Haltmayer M, Mueller T: Association of adiponectin and aminoterminal proBNP in peripheral arterial disease. Clin Chim Acta 2007, 377:192-197.
• [8]Mueller T, Dieplinger B, Poelz W, Endler G, Wagner OF, Haltmayer M: Aminoterminal pro-B-type natriuretic peptide as predictor of mortality in patients with symptomatic peripheral arterial disease: 5-year follow-up data from the linz peripheral arterial disease study. Clin Chem 2009, 55:68-77.
• [9]Ye Z, Ali Z, Klee GG, Mosley TH Jr, Kullo IJ: Associations of candidate biomarkers of vascular disease with the ankle-brachial index and peripheral arterial disease. Am J Hypertens 2013, 26:495-502.
• [10]Salomaa V, Havulinna A, Saarela O, Zeller T, Jousilahti P, Jula A, Muenzel T, Aromaa A, Evans A, Kuulasmaa K, Blankenberg S: Thirty-one novel biomarkers as predictors for clinically incident diabetes. PLoS One 2010, 5:e10100.
• [11]Pfister R, Sharp S, Luben R, Welsh P, Barroso I, Salomaa V, Meirhaeghe A, Khaw KT, Sattar N, Langenberg C, Wareham NJ: Mendelian randomization study of B-type natriuretic peptide and type 2 diabetes: evidence of causal association from population studies. PLoS Med 2011, 8:e1001112.
• [12]Newton-Cheh C, Larson MG, Vasan RS, Levy D, Bloch KD, Surti A, Guiducci C, Kathiresan S, Benjamin EJ, Struck J, Morgenthaler NG, Bergmann A, Blankenberg S, Kee F, Nilsson P, Yin X, Peltonen L, Vartiainen E, Salomaa V, Hirschhorn JN, Melander O, Wang TJ: Association of common variants in NPPA and NPPB with circulating natriuretic peptides and blood pressure. Nat Genet 2009, 41:348-353.
• [13]Expert Committee on the Diagnosis and Classification of Diabetes Mellitus: Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 2003, 26:S5-S20.
• [14]Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM Jr, White CJ, White J, White RA, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B, et al.: ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease. Circulation 2006, 113:e463-e654.
• [15]Molitch ME, DeFronzo RA, Franz MJ, Keane WF, Mogensen CE, Parving HH, American Diabetes Association: Diabetic nephropathy. Diabetes Care 2003, 26:S94-S98.
• [16]Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, Galderisi M, Grobbee DE, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Ruilope LM, Schmieder RE, Sirnes PA, Sleight P, Viigimaa M, Waeber B, Zannad F, Redon J, Dominiczak A, Narkiewicz K, Nilsson PM, Burnier M, et al.: 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013, 34:2159-2219.
• [17]McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Køber L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Rønnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A, ESC Committee for Practice Guidelines: ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012, 33:1787-1847.
• [18]Boulton AJ, Vinik AI, Arezzo JC, Bril V, Feldman EL, Freeman R, Malik RA, Maser RE, Sosenko JM, Ziegler D, American Diabetes Association: Diabetic neuropathies: a statement by the American diabetes association. Diabetes Care 2005, 28:956-962.
• [19]Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in adults: Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA 2001, 285:2486-2497.
• [20]Joosten MM, Pai JK, Bertoia ML, Rimm EB, Spiegelman D, Mittleman MA, Mukamal KJ: Associations between conventional cardiovascular risk factors and risk of peripheral artery disease in men. JAMA 2012, 308:1660-1667.
• [21]Jude EB, Eleftheriadou I, Tentolouris N: Peripheral arterial disease in diabetes – a review. Diabet Med 2010, 27:4-14.
• [22]Aronow WS, Ahn C, Weiss MB, Babu S: Relation of increased hemoglobin A(1c) levels to severity of peripheral arterial disease in patients with diabetes mellitus. Am J Cardiol 2007, 99:1468-1469.
• [23]Görmüş U, Ozmen D, Ozmen B, Parildar Z, Ozdoğan O, Mutaf I, Bayindir O: Serum N-terminal-pro-brain natriuretic peptide (NT-pro-BNP) and homocysteine levels in type 2 diabetic patients with asymptomatic left ventricular diastolic dysfunction. Diabetes Res Clin Pract 2010, 87:51-56.
• [24]Phelan D, Watson C, Martos R, Collier P, Patle A, Donnelly S, Ledwidge M, Baugh J, McDonald K: Modest elevation in BNP in asymptomatic hypertensive patients reflects sub-clinical cardiac remodeling, inflammation and extracellular matrix changes. PLoS One 2012, 7:e49259.
• [25]Chen X, Zhan X, Chen M, Lei H, Wang Y, Wei D, Jiang X: The prognostic value of combined NT-pro-BNP levels and NIHSS scores in patients with acute ischemic stroke. Intern Med 2012, 51:2887-2892.
• [26]Takahashi T, Nakamura M, Onoda T, Ohsawa M, Tanno K, Itai K, Sakata K, Sakuma M, Tanaka F, Makita S, Yoshida Y, Ogawa A, Kawamura K, Okayama A: Predictive value of plasma B-type natriuretic peptide for ischemic stroke: a community-based longitudinal study. Atherosclerosis 2009, 207:298-303.
• [27]Tagore R, Ling LH, Yang H, Daw HY, Chan YH, Sethi SK: Natriuretic peptides in chronic kidney disease. Clin J Am Soc Nephrol 2008, 3:1644-1651.
• [28]Oztekin S, Karakurt O, Yazıhan N, Unal I: Relationship of brain natriuretic peptide with metabolic syndrome parameters: an observational study. Anadolu Kardiyol Derg 2011, 11:678-684.
• [29]Omland T: Advances in congestive heart failure management in the intensive care unit: B-type natriuretic peptides in evaluation of acute heart failure. Crit Care Med 2008, 36:S17-S27.
• [30]Issa VS, Taniguchi LU, Park M, Cruz LM, Bocchi EA, Velasco IT, Soriano F: Positive end-expiratory pressure and renal function influence B-type natriuretic peptide in patients with severe sepsis and septic shock. Arq Bras Cardiol 2008, 91:107-112.
• [31]Clerico A, Giannoni A, Vittorini S, Passino C: Thirty years of the heart as an endocrine organ: physiological role and clinical utility of cardiac natriuretic hormones. Am J Physiol Heart Circ Physiol 2011, 301:H12-H20.
• [32]Criqui MH, Ninomiya JK, Wingard DL, Ji M, Fronek A: Progression of peripheral arterial disease predicts cardiovascular disease morbidity and mortality. J Am Coll Cardiol 2008, 52:1736-1742.
• [33]Fan J, Jouni H, Khaleghi M, Bailey KR, Kullo IJ: Serum N-terminal pro-B-type natriuretic peptide levels are associated with functional capacity in patients with peripheral arterial disease. Angiology 2012, 63:435-442.
• [34]Keda M, Kohno M, Yasunari K, Yokokawa K, Horio T, Ueda M, Morisaki N, Yoshikawa J: Natriuretic peptide family as a novel antimigration factor of vascular smooth muscle cells. Arterioscler Thromb Vasc Biol 1997, 17:731-736.
• [35]Chen H, Levine YC, Golan DE, Michel T, Lin AJ: Atrial natriuretic peptide-initiated cGMP pathways regulate vasodilatorstimulated phosphoprotein phosphorylation and angiogenesis in vascular endothelium. J Biol Chem 2008, 283:4439-4447.
• [36]Park K, Itoh H, Yamahara K, Sone M, Miyashita K, Oyamada N, Sawada N, Taura D, Inuzuka M, Sonoyama T, Tsujimoto H, Fukunaga Y, Tamura N, Nakao K: Therapeutic potential of atrial natriuretic peptide administration on peripheral arterial diseases. Endocrinology 2008, 149:483-491.
• [37]Shmilovich H, Ben-Shoshan J, Tal R, Afek A, Barshack I, Maysel-Auslander S, Harats D, Keren G, George J: B-type natriuretic peptide enhances vasculogenesis by promoting number and func-tional properties of early endothelial progenitor cells. Tissue Eng Part A 2009, 15:2741-2749.
• [38]Talha S, Bouitbir J, Charles AL, Zoll J, Goette-Di Marco P, Meziani F, Piquard F, Geny B: Pretreatment with brain natriuretic peptide reduces skeletal muscle mitochondrial dysfunction and oxidative stress after ischemia-reperfusion. J Appl Physiol 2013, 114:172-179.
• [39]Kuhn M, Völker K, Schwarz K, Carbajo-Lozoya J, Flögel U, Jacoby C, Stypmann J, van Eickels M, Gambaryan S, Hartmann M, Werner M, Wieland T, Schrader J, Baba HA: The natriuretic peptide/guanylyl cyclase–a system functions as a stress-responsive regulator of angiogenesis in mice. J Clin Invest 2009, 119:2019-2030.
• [40]Tokudome T, Kishimoto I, Yamahara K, Osaki T, Minamino N, Horio T, Sawai K, Kawano Y, Miyazato M, Sata M, Kohno M, Nakao K, Kangawa K: Impaired recovery of blood flow after hind-limb ischemia in mice lacking guanylyl cyclase-a, a receptor for atrial and brain natriuretic peptides. Arterioscler Thromb Vasc Biol 2009, 29:1516-1521.
• [41]Schirger JA, Grantham JA, Kullo IJ, Jougasaki M, Wennberg PW, Chen HH, Lisy O, Miller V, Simari RD, Burnett JC Jr: Vascular actions of brain natriuretic peptide: modulation by atherosclerosis and neutral endopeptidase inhibition. J Am Coll Cardiol 2000, 35:796-801.
• [42]Gruden G, Barutta F, Chaturvedi N, Schalkwijk C, Stehouwer CD, Pinach S, Manzo M, Loiacono M, Tricarico M, Mengozzi G, Witte DR, Fuller JH, Perin PC, Bruno G: NH2-terminal probrain natriuretic peptide is associated with diabetes complications in the EURODIAB Prospective Complications Study: the role of tumor necrosis factor-α. Diabetes Care 2012, 35:1931-1936.