1. Circulating ImP levels are associated with T2D (P < 0.01);2. CVD and HF patients have higher ImP levels than those without (P < 0.001);3. The highest ImP quartile significantly increases HF risk (adjusted OR = 2.89, P < 0.001);4. Elevated ImP levels are associated with reduced LVEF (adjusted P < 0.01);5. NT-proBNP levels rise with higher ImP quartiles (adjusted P < 0.0001);6. High ImP (Q4) predicts higher mortality risk (adjusted HR = 1.85, P < 0.01);7. ImP outperforms traditional predictors for 5-year mortality (P < 0.01). Here, NPPB is linked to type 2 diabetes mellitus.