02668nas a2200289 4500008004100000022001400041245014400055210006900199260001300268300001200281490000700293520175800300100002402058700001902082700002302101700001802124700002402142700001902166700001702185700002402202700002402226700002202250700002002272700003002292700002002322856003602342 2016 eng d a1532-860000aLongitudinal assessment of N-terminal pro-B-type natriuretic peptide and risk of diabetes in older adults: The cardiovascular health study.0 aLongitudinal assessment of Nterminal proBtype natriuretic peptid c2016 Oct a1489-970 v653 a

INTRODUCTION: Natriuretic peptides have a well-recognized role in cardiovascular homeostasis. Recently, higher levels of B-type natriuretic peptide (BNP) have also been associated with decreased risk of diabetes in middle-aged adults. Whether this association persists into older age, where the pathophysiology of diabetes changes, has not been established, nor has its intermediate pathways.

METHODS: We investigated the relationship between N-terminal (NT)-proBNP and incident diabetes in 2359 older adults free of cardiovascular disease or chronic kidney disease in the Cardiovascular Health Study.

RESULTS: We documented 348 incident cases of diabetes over 12.6years of median follow-up. After adjusting for age, sex, race, body mass index, systolic blood pressure, anti-hypertensive treatment, smoking, alcohol use, and LDL, each doubling of NT-proBNP was associated with a 9% lower risk of incident diabetes (HR=0.91 [95% CI: 0.84-0.99]). Additional adjustment for waist circumference, physical activity, estimated glomerular filtration rate or C-reactive protein did not influence the association. Among putative mediators, HDL and triglycerides, adiponectin, and especially homeostasis model assessment of insulin resistance, all appeared to account for a portion of the lower risk associated with NT-proBNP.

CONCLUSION: In older adults without prevalent cardiovascular or kidney disease, higher NT-proBNP is associated with decreased risk of incident diabetes even after adjustment for traditional risk factors. These findings suggest that the metabolic effects of natriuretic peptides persist late in life and offer a potential therapeutic target for prevention of diabetes in older people.

1 aBrutsaert, Erika, F1 aBiggs, Mary, L1 aDelaney, Joseph, A1 aDjoussé, Luc1 aGottdiener, John, S1 aIx, Joachim, H1 aKim, Francis1 aMukamal, Kenneth, J1 aSiscovick, David, S1 aTracy, Russell, P1 ade Boer, Ian, H1 adeFilippi, Christopher, R1 aKizer, Jorge, R uhttps://chs-nhlbi.org/node/7242