The Influence of Diabetes Mellitus on Midregional Proadrenomedullin Concentrations and Prognostic Value in Heart Failure Outpatients

Abstract Background Diabetes mellitus (DM) is associated with an adverse outcome in heart failure (HF). Increased concentrations of midregional proadrenomedullin (MR-proADM) have been associated with DM and are predictors of mortality in HF patients. The aim of this study was to elucidate the impact of DM on MR-proADM concentrations and the prognostic value regarding all-cause mortality and hospitalization among HF patients. Methods and Results We included 366 patients from an HF clinic; 69 (19%) had a history of DM and 40 (11%) had newly diagnosed DM (HbA1c ≥48 mmol/mol). The median MR-proADM concentration was unaffected by DM status ( P = .20) but increased in HF patients with impaired renal function ( P < .001). During a median follow-up of 55 months, 189 died, and 292 either died or were hospitalized. After adjustment for clinically relevant parameters, MR-proADM was associated with all-cause mortality (hazard ratio [HR] 1.3, 95% confidence interval [CI] 1.1–1.4; P = .01) and the combined end point of death and hospitalization (HR 1.2, 95% CI 1.1–1.4; P = .02) per 1 SD increment of ln-transformed variable. No interaction between DM and MR-proADM was found regarding mortality or hospitalization. Conclusions Diabetes status had no impact on MR-proADM concentrations or in the predictive ability of MR-proADM in HF patients.