The fact that people with diabetes had a lower median NT-proBNP value despite their worse New York Heart Association class in the current and previous studies may be explained in part by their higher body mass index, because obesity has been associated with lower levels of natriuretic peptides.12 In addition, patients with diabetes studied herein also had a lower prevalence of atrial fibrillation history at baseline compared with those without diabetes, which may explain further their lower baseline NT-proBNP values. Here, NPPB is linked to diabetes mellitus.