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- Title
BNP Is a Predictor for Possible Future Development of Heart Failure in Patients with Edema Development During Glitazone Therapy.
- Authors
Borchert, Marcus; Hohberg, Cloth; Lübben, Georg; Brandenburg, Dietrich; Forst, Thomas; Pfützner, Andreas
- Abstract
Patients with type 2 diabetes mellitus treated with glitazones have a risk for fluid retention and edema. We performed a safety subanalysis analysis of the PiOneer study to investigate the correlation between edema, fluid retention and the levels of brain natriuric peptide (BNP), a suggested laboratory marker for heart failure. The Pioneer study investigated the glucose independent effects of pioglitazone-based therapy (45mg/day) versus glimepiride-based treatment (2.7±1.6mg/day) for 24 weeks in a randomized controlled study in 180 orally treated patients with type 2 diabetes (69 women, 111 men, age(mean±SD): 62.8±7.7 years; body mass index: 31.9±4.7 kg/m²; HbA[sub 1c]: 7.5 ± 0.9%). Observation parameters for this safety analysis were BNP levels at the beginning and endpoint and adverse event reports related to edema, fluid retention and dyspnea. Edema was investigated with special attention also to mild forms and was reported for 8 patients in the glimepiride group (9.1%) and 28 patients in the pioglitazone group (30.4%). BNP levels increased in the pioglitazone group from 30±36 pg/ml to 39±43 pg/ml (p<0.05, glimepiride: 29±35 pg/ml to 28±43 pg/ml, n.s.). Five patients in the pioglitazone arm had increased BNP levels at baseline (> 100 pg/ml) and four of them dropped out for suspicious but not confirmed heart failure or dyspnea throughout the trial. In total, suspect heart failure or dyspnea was reported from 7 patients in the pioglitazone arm who had higher BNP levels at baseline and endpoint (96±75 pg/ml; 135±47 pg/ml), as compared to patients without these symptoms (30±31 pg/ml; 41±39 pg/mi, p<0.001 at both time-points). Patients with edema had comparable BNP levels at endpoint (41±39 pg/ml) as patients without edema (33±39 pg/ml, n.s.). Conclusion: In this study, BNP elevation (> 100 pg/ml) was not associated with edema formation but with suspect heart failure and dyspnea. It may, therefore, be a valuable marker for identifying patients, who have a high risk for heart failure development in case of clinically relevant fluid retention during glitazone therapy.
- Subjects
PEPTIDES; HEART failure; EDEMA; HYPOGLYCEMIC agents; TYPE 2 diabetes
- Publication
Diabetes, 2007, Vol 56, pA65
- ISSN
0012-1797
- Publication type
Article