Neurohormonal profile of patients with heart failure and diabetes

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], Nterminal (pro)ANP, brain natriuretic peptide [BNP] and Nterminal (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 pmol/l, p=0.03), while a similar trend was observed for Nterminal (pro)BNP (750 vs. 554 pmol/l, p=0.10). During almost five years of followup, 51/81 patients with diabetes died (63%), as compared with 144 of 290 nondiabetic patients (50%) who died (p=0.046). Natriuretic peptides and noradrenaline were the most powerful predictors of mortality in both diabetic and nondiabetic HF patients. Conclusion. HF patients with diabetes have higher (Nterminal (pro)) BNP levels than nondiabetic patients, while other neurohormones are generally similar. Natriuretic peptides are also good prognostic markers in diabetic HF patients.

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