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Diabetes Care. 2016 May;39(5):677-85. doi: 10.2337/dc15-1760. Epub 2016 Jan 6.

Natriuretic Peptide and High-Sensitivity Troponin for Cardiovascular Risk Prediction in Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study.

Author information

  • 1Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA Cardiovascular Department, Azienda Ospedaliera Papa Giovanni XXIII Hospital, Bergamo, Italy.
  • 2Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA Vanderbilt Heart and Vascular Institute, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
  • 3Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA.
  • 4Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore MD, and Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
  • 5Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN.
  • 6Department of Epidemiology, Johns Hopkins University, Baltimore, MD.
  • 7Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA NewYork-Presbyterian/Columbia University Medical Center, New York, NY.
  • 8Department of Pharmacy, University of Wisconsin School of Pharmacy, Madison, WI.
  • 9National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD.
  • 10Section of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX.
  • 11Departments of Medicine and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI.
  • 12Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI.
  • 13Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX.
  • 14Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA ssolomon@rics.bwh.harvard.edu.

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.

© 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

PMID:
26740635
[PubMed - in process]
PMCID:
PMC4839173
[Available on 2017-05-01]
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