The following is a summary of “NT‐proBNP Mediates the Association Between FGF23 and All‐Cause Mortality in Individuals With Type 2 Diabetes,” published in the November 2023 issue of Cardiology by Vaart et al.

In individuals with type 2 diabetes, the correlation between higher fibroblast growth factor 23 (FGF23) levels and increased mortality risk has been established, yet the underlying mechanism remains unclear. This study aimed to delve into whether N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) mediates the connection between FGF23 and mortality. In a cohort of 399 patients with type 2 diabetes, C‐terminal FGF23 and NT‐proBNP levels were assessed. Cox regression analyses were conducted, and Structural Equation Modeling was employed for mediation analysis. Over a follow-up period of 9.2 years, 117 individuals died. 

Results showed a notable association between FGF23 and all-cause mortality, independent of potential confounders (fully adjusted hazard ratio [HR] of 2.32 [95% CI, 1.21–4.43], P=0.01). However, after further adjusting for NT‐proBNP, this association diminished (HR of 1.84 [95% CI, 0.91–3.73]). NT‐proBNP explained around 26% of the mediation effect between FGF23 and all-cause mortality. These findings suggest that higher FGF23 levels in individuals with type 2 diabetes might contribute to increased mortality through its influence on volume homeostasis.

Source: ahajournals.org/doi/10.1161/JAHA.123.031873