The relative and combined ability of high-sensitivity cardiac troponin t and n-terminal pro-b-type natriuretic peptide to predict cardiovascular events and death in patients with type 2 diabetes

Graham Hillis, Paul L Welsh, John P Chalmers, Vlado Perkovic, Clara Chow, Qiang Li, Min Jun, Bruce Neal, Sophia Zoungas, Neil R Poulter, Giuseppe Mancia, Bryan Williams, Naveed Sattar, Mark Woodward

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Objective Current methods of risk stratification in patients with type 2 diabetes are suboptimal. The current study assesses the ability of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) to improve the prediction of cardiovascular events and death in patients with type 2 diabetes. Research Design And Methods A nested case-cohort study was performed in 3,862 patients who participated in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. Results Seven hundred nine (18 ) patients experienced a major cardiovascular event (composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) and 706 (18 ) died during a median of 5 years of follow-up. In Cox regression models, adjusting for all established risk predictors, the hazard ratio for cardiovascular events for NT-proBNP was 1.95 per 1 SD increase (95 CI 1.72, 2.20) and the hazard ratio for hs-cTnT was 1.50 per 1 SD increase (95 CI 1.36, 1.65). The hazard ratios for death were 1.97 (95 CI 1.73, 2.24) and 1.52 (95 CI 1.37, 1.67), respectively. The addition of either marker improved 5-year risk classification for cardiovascular events (net reclassification index in continuous model, 39 for NTproBNP and 46 for hs-cTnT). Likewise, both markers greatly improved the accuracywith which the 5-year risk of death was predicted. The combination of both markers provided optimal risk discrimination. Conclusions NT-proBNP and hs-cTnT appear to greatly improve the accuracy with which the risk of cardiovascular events or death can be estimated in patients with type 2 diabetes.
Original languageEnglish
Pages (from-to)295 - 303
Number of pages9
JournalDiabetes Care
Issue number1
Publication statusPublished - 2014

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