Emerging diagnostic and predictive utilities of natriuretic peptides in diabetes mellitus patients at high cardiovascular risk

Pre-diabetes and diabetes mellitus (DM) are established cardiovascular (CV) risk factors, which contribute to heart failure (HF) with reduced (HFrEF) and preserved (HFpEF) ejection fraction. Natriuretic peptides (NPs) were found to be useful tool for CV risk stratification among patients with pre-diabetes and T2DM regardless of HF. Previous clinical studies have shown that elevated levels of NPs predicted all-cause and CV mortality, risk of HF manifestation and progression, as well as risk re-admission due to HF. The discriminative potency of NPs for CV death and HF-related events in pre-diabetes and T2DM populations has not been demonstrated beyond traditional CV risk factors. The aim of the review is to accumulate knowledge regarding differential prognostic role of circulating NPs in patients with prediabetes and established T2DM. Presences of HFrEF or HFpEF in T2DM patients may require modification of NP cut-off points to primary diagnose HF and determine HF-related risks. There are several controversies between clinical outcomes and dynamic of circulating levels of NPs in diabetics treated with glucagon-like peptide-1 agonists and sodium-glucose co-transporter-2 inhibitors that requires to be elucidated in large clinical studies in the future.