Neth Heart J. 2010 Apr;18(4):190-6. doi: 10.1007/BF03091760.

Neurohormonal profile of patients with heart failure and diabetes.

Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation

I C C van der Horst, R A de Boer, H L Hillege, F Boomsma, A A Voors, D J van Veldhuisen

PMID: 20428417 PMCID: PMC2856867 DOI: 10.1007/BF03091760

Abstract

Background. Neurohormonal activation is generally recognised to play an important role in the pathophysiology, prognosis and treatment of chronic heart failure (HF). While the number of patients with diabetes increases, little if anything is known about neurohormonal activation in HF patients with diabetes. Methods. The study population consisted of 371 patients with advanced HF who were enrolled in a multicentre survival trial. Ten different plasma neurohormones were measured (noradrenaline, adrenaline, dopamine, aldosterone, renin, endothelin, atrial natriuretic peptide [ANP], N-terminal (pro)ANP, brain natriuretic peptide [BNP] and N-terminal (pro)BNP. Comparisons were made between patients with diabetes (n=81) and those without (n=290). Results. At baseline, the two groups were comparable regarding age (mean 68 years), left ventricular ejection fraction (23%), severity and aetiology of HF, while body weight was higher in those with diabetes (77.4 vs. 74.2 kg, p=0.04). Most plasma neurohormones were similar between groups, but patients with diabetes had higher values of BNP (94 vs. 47 pmol/l, p=0.03), while a similar trend was observed for N-terminal (pro)BNP (750 vs. 554 pmol/l, p=0.10). During almost five years of follow-up, 51/81 patients with diabetes died (63%), as compared with 144 of 290 non-diabetic patients (50%) who died (p=0.046). Natriuretic peptides and noradrenaline were the most powerful predictors of mortality in both diabetic and non-diabetic HF patients. Conclusion. HF patients with diabetes have higher (N-terminal (pro)) BNP levels than non-diabetic patients, while other neurohormones are generally similar. Natriuretic peptides are also good prognostic markers in diabetic HF patients. (Neth Heart J 2010;18:190-6.).

Keywords: Diabetes Mellitus; Heart Failure; Neurotransmitter Agents

References

1. Am J Cardiol. 1974 Jul;34(1):29-34 - PubMed
2. Circulation. 1990 Nov;82(5):1730-6 - PubMed
3. Eur Heart J. 1999 May;20(9):666-72 - PubMed
4. J Am Coll Cardiol. 2004 Sep 1;44(5):1047-52 - PubMed
5. Diabetes Care. 2004 Aug;27(8):1929-35 - PubMed
6. Neth Heart J. 2010 Apr;18(4):190-6 - PubMed
7. Diabetes Metab. 2008 Sep;34(4 Pt 1):355-62 - PubMed
8. J Am Coll Cardiol. 2001 Aug;38(2):421-8 - PubMed
9. Eur J Heart Fail. 2005 Jan;7(1):81-6 - PubMed
10. Clin Sci (Lond). 1996 Mar;90(3):189-95 - PubMed
11. Arch Intern Med. 2008 Feb 11;168(3):316-24 - PubMed
12. Eur J Heart Fail. 2008 Oct;10(10):933-89 - PubMed
13. JAMA. 2007 Nov 7;298(17):2009-19 - PubMed
14. Eur Heart J. 2004 Apr;25(8):656-62 - PubMed
15. Europace. 2006 Jul;8(7):482-7 - PubMed
16. Lancet. 1997 Apr 5;349(9057):971-7 - PubMed
17. Am J Cardiol. 1996 May 1;77(11):1017-20 - PubMed
18. Curr Opin Cardiol. 2008 Jul;23(4):340-9 - PubMed
19. Neth Heart J. 2008 Apr;16(4):123-8 - PubMed
20. Diabetologia. 1999 Dec;42(12):1383-94 - PubMed
21. Trends Cardiovasc Med. 2008 Nov;18(8):280-92 - PubMed
22. J Am Coll Cardiol. 1992 Jul;20(1):248-54 - PubMed
23. Eur J Heart Fail. 2007 Dec;9(12):1146-55 - PubMed
24. Am J Cardiol. 1998 May 15;81(10):1207-10 - PubMed
25. Am J Cardiol. 1982 May;49(7):1659-66 - PubMed
26. Diabete Metab. 1989;15(5 Pt 2):301-5 - PubMed
27. Eur Heart J. 2004 Feb;25(4):292-9 - PubMed
28. N Engl J Med. 1999 Aug 19;341(8):577-85 - PubMed

Publication Types

• Journal Article