Guideline-Based Elevated NT-proBNP Among Asymptomatic Adults with Diabetes in Saudi Arabia: Prevalence and Real-World...

Early identification allows timely guideline-directed therapy to prevent progression to symptomatic heart failure (HF). N-terminal pro-B-type natriuretic peptide (NT-proBNP) is an established biomarker for screening asymptomatic patients at risk of HF, yet real-world outpatient data in the Middle East are scarce. This study aimed to identify adults with NT-proBNP ≥ 125 pg/mL who may need cardiac evaluation and recognize clinical predictors of elevated NT-proBNP.

This retrospective chart review included adults with type 1 or type 2 diabetes mellitus (DM) (≥ 18 years) tested for NT-proBNP at a tertiary care center in Riyadh, Saudi Arabia (January 2024-June 2025). Individuals with prior HF or advanced chronic kidney disease were excluded. NT-proBNP ≥ 125 pg/mL defined patients at increased risk of pre-HF. Multivariable logistic regression analysis assessed variables independently related to NT-proBNP above the prespecified cutoff.

Among 152 patients (median age 54 years; 41.5% female), those with type 2 DM were older than those with type 1 DM (median age 58 vs. 38 years), had higher body mass index (median 30.1 vs. 26.8 kg/m²), and had a greater burden of cardiometabolic comorbidities (hypertension 61.2% vs. 26.1%; dyslipidemia 71.3% vs. 30.4%). In the type 2 DM subgroup (n = 129), 52.7% had NT-proBNP ≥ 125 pg/mL (median DM duration 17 years). NT-proBNP levels were higher in older patients (adjusted OR 1.13/year; p = 0.029) as well as in patients with higher systolic blood pressure (adjusted OR 1.09/mmHg; p = 0.007), as assessed using multivariable analysis.

More than half of asymptomatic adults with type 2 DM had NT-proBNP levels exceeding the American Diabetes Association (ADA)-recommended threshold of ≥ 125 pg/mL, suggesting a substantial burden of pre-‍HF in an outpatient setting. NT-proBNP-based screening could facilitate early identification of high-risk patients, facilitating timely cardiac evaluation with initiation of guideline-directed therapies to prevent, delay, or avert progression to symptomatic HF.