NT‐proBNP Mediates the Association Between FGF23 and All‐Cause Mortality in Individuals With Type 2 Diabetes

Amarens van der Vaart*, Stephan J.L. Bakker, Gozewijn D. Laverman, Peter R. van Dijk, Martin H. de Borst

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background: FGF23 (fibroblast growth factor 23) is associated with a higher mortality risk in type 2 diabetes, but the mechanism is unclear. We aimed to study whether NT‐proBNP (N‐terminal pro‐brain natriuretic peptide) mediates the association between FGF23 and mortality.
Methods and Results: We analyzed C‐terminal FGF23 and NT‐proBNP levels in 399 patients with type 2 diabetes. Cox regression analyses were performed, followed by mediation analyses using Structural Equation Modeling. During follow‐up of 9.2 [7.6–11.3] years, 117 individuals died. FGF23 was associated with all‐cause mortality, independent of potential confounders (fully adjusted hazard ratio [HR], 2.32 [95% CI, 1.21–4.43], P=0.01). The association was lost upon further adjustment for NT‐proBNP (HR, 1.84; 95% CI, 0.91–3.73). NT‐proBNP accounted for 26% of the mediation effect between FGF23 and all‐cause mortality.
Conclusions: These findings suggest that a higher FGF23 level is associated with increased mortality in individuals with type 2 diabetes through an effect on volume homeostasis.
Original languageEnglish
Article numbere031873
Number of pages5
JournalJournal of the American Heart Association
Volume12
Issue number23
Early online date28 Nov 2023
DOIs
Publication statusPublished - 5 Dec 2023
Externally publishedYes

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