Current guidelines recommend screening for subclinical heart failure and related CV events with N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with type 2 diabetes (T2DM). The utility of this biomarker in relatively low-risk populations, namely, subjects in the community care setting, is currently less known. This study aimed to evaluate the feasibility of incorporating NT-proBNP in the regular diabetes complication assessment (DMCA) for early assessment of CV risk in patients with T2DM.

Four-hundred-and-one asymptomatic Chinese patients with T2DM were recruited prospectively from a community health awareness program and an ambulatory specialist clinic in Hong Kong from January 2022 to June 2024. All participants underwent measurement of NT-proBNP using an electrochemiluminescent immunoassay (Roche Diagnostics) in addition to regular DMCA. A cutoff of ≥125 pg/ml was used to define elevated NT-proBNP. The prevalence of and factors associated with elevated NT-proBNP were determined. Association between elevated NT-proBNP and incident CV death or heart failure requiring hospitalization (HFH) / urgent visits for HF within three years of follow up were analysed using Cox regression.

The subjects were 44.1% female. Their mean age was 63±11 years, diabetes duration 11±9 years, HbA1c 7.0±1.1% and eGFR 88±20 ml/min/1.73m2. The median (IQR) NT-proBNP level was 34(53)pg/ml. Fifty-seven (14%) subjects had elevated NTproBNP with a median (IQR) of 233(417)pg/ml. Older age (OR 2.7, p=0.05) and albuminuria (OR 4.7, p<0.01) were significant predictors for elevated NTproBNP on multivariable analysis. Among 264 subjects with outcomes ascertained, 15 (5.7%) experienced CV death or HFH / urgent visits for HF over a median 24-month’s follow-up. Adjusting for age at baseline, sex, eGFR, HbA1c and other co-variates, elevated NT-proBNP was associated with incident CV death or HFH / urgent visit for HF (HR 7.0 [1.1, 46], p=0.043). Elevated NT-proBNP had better discriminative ability for the endpoint than urine albumin-to-creatinine ratio (UACR) and HbA1c based on ROC analysis (AUCs for NT-proBNP, UACR and HbA1c: 0.93 [0.85-1.0], 0.76 [0.58-0.95], and 0.53 [0.33-0.73] respectively).

Elevated NT-proBNP was found in a significant proportion of patients with T2DM in the community care setting and carried good prognostic value. This simple serum biomarker is useful to assist early identification of patients at high HF and CV risk, and potentially facilitates timely intervention.