A Component of the Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF) Programme
Professor John GF Cleland
Hull York Medical School, University of Hull
Kingston-upon-Hull. UK
The research has received funding from the European Union Seventh Framework Programme [FP7/2007-2011] under grant agreement n° 241558 (SICA-HF) and from the Russian Ministry of Science and Education within the FTP "R&D in priority fields of the S&T complex of Russia 2007-2012 under state contract n° 02.527.11.0007.
Recent clinical trials show that the risk of a patient with Type-2 Diabetes Mellitus (T2DM) dying is about 1% per year and the risk of death or a major cardiovascular problem is about 2% per year. Most clinical trials operate within a 5-year time-horizon and therefore most patients with T2DM (~90%) do not develop serious cardiac problems. Problems that don’t happen cannot be prevented! There are at least three main responses to the above:-
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We have investigated the ability of a plasma marker of cardio-renal stress, amino-terminal pro-brain natriuretic peptide (NT-proBNP) to identify the risk of death or cardiovascular events in patients more than 1,000 patients aged >40 years with T2DM requiring pharmacological intervention to improve glycaemia. Patients with pre-existing heart failure or a recent major cardiovascular or surgical event were excluded. The median age of patients was 65 (IQR: 58-72) years and 469 (42%) were women. About 70% of patients had a plasma NT-proBNP concentration <125ng/L (the threshold proposed by the European Society of Cardiology below which a diagnosis of heart failure is highly unlikely) – Figure 1. Increases in NT-proBNP were most often associated with left atrial dilatation (LA Dil) Figure 2 and less frequently with left ventricular systolic dysfunction (LVSD), atrial fibrillation (AF) or renal dysfunction (eGFR). For those with an NT-proBNP <125ng/L, mortality was <1% and the risk of death or hospitalisation ~2.5% at one year. However, in those with an NT-proBNP >250ng/L mortality was >7% and risk of death or hospitalisation almost 20%.
This research highlights the potential role of bio-markers not only for the identification of risk but for the identification of patients with unmet needs who may benefit from more aggressive or innovative therapy and participation in research programmes.