Cardiac stress and inflammatory markers as predictors of heart failure in patients with type 2 diabetes: The ADVANCE trial

Toshiaki Ohkuma, Min Jun, Mark Woodward, Sophia Zoungas, Mark E. Cooper, Diederick E. Grobbee, Pavel Hamet, Giuseppe Mancia, Bryan Williams, Paul L Welsh, Naveed A Sattar, Jonathan E. Shaw, Kazem Rahimi, John Chalmers

Research output: Contribution to journalArticleResearchpeer-review

Abstract

OBJECTIVE This study examined the individual and combined effect of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), interleukin-6 (IL-6), and hs-CRP on the prediction of heart failure incidence or progression in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS A nested case-cohort studywas conducted in 3,098 participants with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. RESULTS A higher value of each biomarker was significantly associated with a higher risk of heart failure incidence or progression, after adjustment for major risk factors. The hazard ratios per 1-SD increase were 3.06 (95% CI 2.37, 3.96) for NT-proBNP, 1.50 (1.27, 1.77) for hs-cTnT, 1.48 (1.27, 1.72) for IL-6, and 1.32 (1.12, 1.55) for hs-CRP. The addition of NT-proBNP to the model including conventional risk factorsmeaningfully improved 5-year risk-predictive performance (C statistic 0.8162 to 0.8800; continuous net reclassification improvement [NRI] 73.1%; categorical NRI [<5%, 5-10%, >10% 5-year risk] 24.2%). In contrast, the addition of hs-cTnT, IL-6, or hs-CRP did not improve the prediction metrics consistently in combination or when added to NT-proBNP. CONCLUSIONS Only NT-proBNP strongly and consistently improved the prediction of heart failure in patients with type 2 diabetes beyond a wide range of clinical risk factors and biomarkers.

Original languageEnglish
Pages (from-to)1203-1209
Number of pages7
JournalDiabetes Care
Volume40
Issue number9
DOIs
Publication statusPublished - 1 Sep 2017

Cite this

Ohkuma, Toshiaki ; Jun, Min ; Woodward, Mark ; Zoungas, Sophia ; Cooper, Mark E. ; Grobbee, Diederick E. ; Hamet, Pavel ; Mancia, Giuseppe ; Williams, Bryan ; Welsh, Paul L ; Sattar, Naveed A ; Shaw, Jonathan E. ; Rahimi, Kazem ; Chalmers, John. / Cardiac stress and inflammatory markers as predictors of heart failure in patients with type 2 diabetes : The ADVANCE trial. In: Diabetes Care. 2017 ; Vol. 40, No. 9. pp. 1203-1209.
@article{57f1917950a14ac68a98f9a85259b55e,
title = "Cardiac stress and inflammatory markers as predictors of heart failure in patients with type 2 diabetes: The ADVANCE trial",
abstract = "OBJECTIVE This study examined the individual and combined effect of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), interleukin-6 (IL-6), and hs-CRP on the prediction of heart failure incidence or progression in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS A nested case-cohort studywas conducted in 3,098 participants with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. RESULTS A higher value of each biomarker was significantly associated with a higher risk of heart failure incidence or progression, after adjustment for major risk factors. The hazard ratios per 1-SD increase were 3.06 (95{\%} CI 2.37, 3.96) for NT-proBNP, 1.50 (1.27, 1.77) for hs-cTnT, 1.48 (1.27, 1.72) for IL-6, and 1.32 (1.12, 1.55) for hs-CRP. The addition of NT-proBNP to the model including conventional risk factorsmeaningfully improved 5-year risk-predictive performance (C statistic 0.8162 to 0.8800; continuous net reclassification improvement [NRI] 73.1{\%}; categorical NRI [<5{\%}, 5-10{\%}, >10{\%} 5-year risk] 24.2{\%}). In contrast, the addition of hs-cTnT, IL-6, or hs-CRP did not improve the prediction metrics consistently in combination or when added to NT-proBNP. CONCLUSIONS Only NT-proBNP strongly and consistently improved the prediction of heart failure in patients with type 2 diabetes beyond a wide range of clinical risk factors and biomarkers.",
author = "Toshiaki Ohkuma and Min Jun and Mark Woodward and Sophia Zoungas and Cooper, {Mark E.} and Grobbee, {Diederick E.} and Pavel Hamet and Giuseppe Mancia and Bryan Williams and Welsh, {Paul L} and Sattar, {Naveed A} and Shaw, {Jonathan E.} and Kazem Rahimi and John Chalmers",
year = "2017",
month = "9",
day = "1",
doi = "10.2337/dc17-0509",
language = "English",
volume = "40",
pages = "1203--1209",
journal = "Diabetes Care",
issn = "0149-5992",
publisher = "Am Diabetes Assoc",
number = "9",

}

Ohkuma, T, Jun, M, Woodward, M, Zoungas, S, Cooper, ME, Grobbee, DE, Hamet, P, Mancia, G, Williams, B, Welsh, PL, Sattar, NA, Shaw, JE, Rahimi, K & Chalmers, J 2017, 'Cardiac stress and inflammatory markers as predictors of heart failure in patients with type 2 diabetes: The ADVANCE trial' Diabetes Care, vol. 40, no. 9, pp. 1203-1209. https://doi.org/10.2337/dc17-0509

Cardiac stress and inflammatory markers as predictors of heart failure in patients with type 2 diabetes : The ADVANCE trial. / Ohkuma, Toshiaki; Jun, Min; Woodward, Mark; Zoungas, Sophia; Cooper, Mark E.; Grobbee, Diederick E.; Hamet, Pavel; Mancia, Giuseppe; Williams, Bryan; Welsh, Paul L; Sattar, Naveed A; Shaw, Jonathan E.; Rahimi, Kazem; Chalmers, John.

In: Diabetes Care, Vol. 40, No. 9, 01.09.2017, p. 1203-1209.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Cardiac stress and inflammatory markers as predictors of heart failure in patients with type 2 diabetes

T2 - The ADVANCE trial

AU - Ohkuma, Toshiaki

AU - Jun, Min

AU - Woodward, Mark

AU - Zoungas, Sophia

AU - Cooper, Mark E.

AU - Grobbee, Diederick E.

AU - Hamet, Pavel

AU - Mancia, Giuseppe

AU - Williams, Bryan

AU - Welsh, Paul L

AU - Sattar, Naveed A

AU - Shaw, Jonathan E.

AU - Rahimi, Kazem

AU - Chalmers, John

PY - 2017/9/1

Y1 - 2017/9/1

N2 - OBJECTIVE This study examined the individual and combined effect of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), interleukin-6 (IL-6), and hs-CRP on the prediction of heart failure incidence or progression in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS A nested case-cohort studywas conducted in 3,098 participants with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. RESULTS A higher value of each biomarker was significantly associated with a higher risk of heart failure incidence or progression, after adjustment for major risk factors. The hazard ratios per 1-SD increase were 3.06 (95% CI 2.37, 3.96) for NT-proBNP, 1.50 (1.27, 1.77) for hs-cTnT, 1.48 (1.27, 1.72) for IL-6, and 1.32 (1.12, 1.55) for hs-CRP. The addition of NT-proBNP to the model including conventional risk factorsmeaningfully improved 5-year risk-predictive performance (C statistic 0.8162 to 0.8800; continuous net reclassification improvement [NRI] 73.1%; categorical NRI [<5%, 5-10%, >10% 5-year risk] 24.2%). In contrast, the addition of hs-cTnT, IL-6, or hs-CRP did not improve the prediction metrics consistently in combination or when added to NT-proBNP. CONCLUSIONS Only NT-proBNP strongly and consistently improved the prediction of heart failure in patients with type 2 diabetes beyond a wide range of clinical risk factors and biomarkers.

AB - OBJECTIVE This study examined the individual and combined effect of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), interleukin-6 (IL-6), and hs-CRP on the prediction of heart failure incidence or progression in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS A nested case-cohort studywas conducted in 3,098 participants with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. RESULTS A higher value of each biomarker was significantly associated with a higher risk of heart failure incidence or progression, after adjustment for major risk factors. The hazard ratios per 1-SD increase were 3.06 (95% CI 2.37, 3.96) for NT-proBNP, 1.50 (1.27, 1.77) for hs-cTnT, 1.48 (1.27, 1.72) for IL-6, and 1.32 (1.12, 1.55) for hs-CRP. The addition of NT-proBNP to the model including conventional risk factorsmeaningfully improved 5-year risk-predictive performance (C statistic 0.8162 to 0.8800; continuous net reclassification improvement [NRI] 73.1%; categorical NRI [<5%, 5-10%, >10% 5-year risk] 24.2%). In contrast, the addition of hs-cTnT, IL-6, or hs-CRP did not improve the prediction metrics consistently in combination or when added to NT-proBNP. CONCLUSIONS Only NT-proBNP strongly and consistently improved the prediction of heart failure in patients with type 2 diabetes beyond a wide range of clinical risk factors and biomarkers.

UR - http://www.scopus.com/inward/record.url?scp=85028081661&partnerID=8YFLogxK

U2 - 10.2337/dc17-0509

DO - 10.2337/dc17-0509

M3 - Article

VL - 40

SP - 1203

EP - 1209

JO - Diabetes Care

JF - Diabetes Care

SN - 0149-5992

IS - 9

ER -