Increases in Natriuretic Peptides Precede Heart Failure Hospitalization in Patients With a Recent Coronary Event and Type 2 Diabetes Mellitus

Patients with a recent coronary event are at high risk of further cardiovascular events, including hospitalization for heart failure (HFH).1,2 Knowledge of the pathophysiological changes preceding HFH provides insight into the temporal course of the progression of HF and may help identify those at imminent risk of this event. B-type natriuretic peptide (BNP) and NT-proBNP (N-terminal prohormone BNP) change rapidly in relation to changes in filling pressures and wall stress, making them useful for monitoring clinical status and response to treatment and clinical status in HF.3 Because there are limited data on temporal changes in natriuretic peptides (NPs) preceding HFH, we examined concentrations of NPs preceding HFH in patients with a recent coronary event and type 2 diabetes mellitus enrolled in the ELIXA trial [Evaluation of Cardiovascular Outcomes in Patients With Type 2 Diabetes After Acute Coronary Syndrome During Treatment With AVE0010 (Lixisenatide); NCT01147250]. The design and primary findings of ELIXA have been published.4 A total of 6068 patients with type 2 diabetes mellitus and an acute coronary syndrome (index event) occurring within 180 days of randomization were enrolled. The trial was designed to assess the efficacy and safety of lixisenatide, a glucagon-like peptide-1 receptor agonist, with respect to cardiovascular morbidity and mortality.5 Sampling of BNP and NT-proBNP occurred at baseline and at weeks 24, 76, and 108 after randomization, yielding 19 585 samples. Samples were collected and analyzed at a core laboratory (Covance Central Laboratory Services, Meyrin, Switzerland). ELIXA was approved by appropriate institutional or central review boards. All participants provided …