Original investigation

Cardiovascular Diabetology

, 11:119

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Plasma NT-proBNP and white matter hyperintensities in type 2 diabetic patients

  • Henrik ReinhardAffiliated withSteno Diabetes Center Email author 
  • , Ellen GardeAffiliated withDanish Research Centre for Magnetic Resonance, Copenhagen University Hospital
  • , Arnold SkimmingeAffiliated withDanish Research Centre for Magnetic Resonance, Copenhagen University Hospital
  • , Per ÅkesonAffiliated withDanish Research Centre for Magnetic Resonance, Copenhagen University Hospital
  • , Thomas Zoëga RamsøyAffiliated withDanish Research Centre for Magnetic Resonance, Copenhagen University HospitalDecision Neuroscience Research Group, Dept. of Marketing, Copenhagen Business School
  • , Kaj WintherAffiliated withDepartment of Clinical Biochemistry, Frederiksberg University Hospital
  • , Hans-Henrik ParvingAffiliated withDepartment of Medical Endocrinology, University Hospital of CopenhagenFaculty of Health Science, Aarhus University
  • , Peter RossingAffiliated withSteno Diabetes Center
  • , Peter K JacobsenAffiliated withSteno Diabetes CenterThe Heart Centre, Rigshospitalet & University of Copenhagen


Elevated plasma N-terminal (NT)-proBNP from the heart as well as white matter hyperintensities (WMH) in the brain predict cardiovascular (CV) mortality in the general population. The cause of poor prognosis associated with elevated P-NT-proBNP is not known but WMH precede strokes in high risk populations. We assessed the association between P-NT-proBNP and WMH or brain atrophy measured with magnetic resonance imaging (MRI) in type 2 diabetic patients, and age-matched controls.

Methods and results

We measured P-NT-proBNP(ng/l) in 20 diabetic patients without prior stroke but with(n = 10) or without(n = 10) asymptomatic coronary artery disease(CAD) in order to include patients with a wide-ranging CV risk profile. All patients and 26 controls had a 3D MRI and brain volumes(ml) with WMH and brain parenchymal fraction(BPF), an indicator of brain atrophy, were determined.

P-NT-proBNP was associated with WMH in linear regression analysis adjusted for CV risk factors(r = 0.94, p = 0.001) and with BPF in univariate analysis(r = 0.57, p = 0.009). Patients divided into groups of increased P-NT-proBNP levels were paralleled with increased WMH volumes(geometric mean[SD];(2.86[5.11] ml and 0.76[2.49] ml compared to patients with low P-NT-proBNP 0.20[2.28] ml, p = 0.003)) and also when adjusted for age, sex and presence of CAD(p = 0.017). The association was strengthened by CV risk factors and we did not find a common heart or brain specific driver of both P-NT-proBNP and WMH. Patients and particular patients with CAD had higher WMH, however no longer after adjustment for age and sex.


P-NT-proBNP was associated with WMH in type 2 diabetic patients, suggesting a linkage between heart and brain disease.


Type 2 diabetes Plasma NT-proBNP 3-D magnetic resonance imaging White matter hyperintensities Brain parenchymal fraction