The Influence of Diabetes Mellitus on Mid-Regional Pro-Adrenomedullin Concentrations and Prognostic Value in Heart Failure Outpatients

BACKGROUND: Diabetes mellitus (DM) is associated with an adverse outcome in heart failure (HF). Increased concentrations of mid-regional pro-adrenomedullin (MR-proADM) have been associated with DM and are predictors of mortality in HF patients. The aim was to elucidate the impact of DM on MR-proADM concentrations and the prognostic value with respect to all-cause mortality and hospitalization among HF patients.

METHODS AND RESULTS: We included 366 patients from a HF clinic 69 (19%) had DM by history and 40 (11%) had newly diagnosed DM (HbA1c ≥ 48 mmol/mol). The median MR-proADM concentration was unaffected by DM status (P = 0.20) but increased in HF patients with impaired renal function (P < 0.001). During a median follow-up of 55 months 189 died, and 292 either died or were hospitalized. After adjustment for clinical relevant parameters, MR-proADM was associated with all-cause mortality HR 1.3 (95% CI: 1.1-1.4, P = 0.01) and the combined endpoint of death and hospitalization HR 1.2 (1.1-1.4, P = 0.02) per 1 SD increment of ln transformed variable. No interaction between DM and MR-proADM was found on mortality or hospitalization.

CONCLUSION: Diabetes status had no impact on MR-proADM concentrations or in the predictive ability of MR-proADM in HF patients.