Natriuretic Peptide and High-Sensitivity Troponin for Cardiovascular Risk Prediction in Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study
Year: 2016
Type: article
Abstract: OBJECTIVE: Cardiovascular disease (CVD) is the major cause of morbidity and mortality in diabetes; yet, heterogeneity in CVD risk has been suggested in diabetes, providing a compelling rationale for improving diabetes risk stratification. We hypothesized that N-terminal prohormone brain natriuretic peptide (NTproBNP) and high-sensitivity troponin T may enhance CVD risk stratification beyond commonly used markers of risk and that CVD risk is heterogeneous in diabetes. RESEARCH DESIGN AND METHODS: Among 8,402 participants without prevalent CVD at visit 4 (1996-1998) of the Atherosclerosis Risk in Communities (ARIC) study there were 1,510 subjects with diabetes (mean age 63 years, 52% women, 31% African American, and 60% hypertensive). RESULTS: Over a median follow-up of 13.1 years, there were 540 incident fatal/nonfatal CVD events (coronary heart disease, heart failure, and stroke). Both troponin T ≥14 ng/L (hazard ratio [HR] 1.96 [95% CI 1.57-2.46]) and NTproBNP >125 pg/mL (1.61 [1.29-1.99]) were independent predictors of incident CVD events at multivariable Cox proportional hazard models. Addition of circulating cardiac biomarkers to traditional risk factors, abnormal electrocardiogram (ECG), and conventional markers of diabetes complications including retinopathy, nephropathy, and peripheral arterial disease significantly improved CVD risk prediction (net reclassification index 0.16 [95% CI 0.07-0.22]). Compared with individuals without diabetes, subjects with diabetes had 1.6-fold higher adjusted risk of incident CVD. However, participants with diabetes with normal cardiac biomarkers and no conventional complications/abnormal ECG (n = 725 [48%]) were at low risk (HR 1.12 [95% CI 0.95-1.31]), while those with abnormal cardiac biomarkers, alone (n = 186 [12%]) or in combination with conventional complications/abnormal ECG (n = 243 [16%]), were at greater risk (1.99 [1.59-2.50] and 2.80 [2.34-3.35], respectively). CONCLUSIONS: Abnormal levels of NTproBNP and troponin T may help to distinguish individuals with high diabetes risk from those with low diabetes risk, providing incremental risk prediction beyond commonly used markers of risk.
Source: Diabetes Care
DOI: 10.2337/dc15-1760
Institutions: Brigham and Women's Hospital, Ospedale Papa Giovanni XXIII, Vanderbilt University, Vanderbilt University Medical Center, Johns Hopkins University, University of Minnesota, Columbia University Irving Medical Center, University of Wisconsin–Madison, Centers for Disease Control and Prevention, National Center for Health Statistics, Baylor College of Medicine
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: G1052397333, G1125241688, G1135917780, G1243299691, G147578628, G1527150935, G1691174148, G173303992, G1941508241, G1941623656, G2039363390, G2513047960, G2818629771, G3114902838, G3410686264, G3462919067, G457330776, Training Program in Cardiovascular Research, Research and Mentoring in the Clinical Epidemiology of Type 2 Diabetes, G567847597, Systolic & diastolic dysfunction in heart failure and preserved ejection fraction, Diabetes and Prediabetes in Older Adults in ARIC, G6548750934, The Vanderbilt Emergency Medicine Research Training Program (VEMRT)
OpenAlex ID: W2228443290