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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Abstract

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
Volume37
Issue number1
DOIs
Publication statusPublished - 2014

Cite this

Hillis, G., Welsh, P. L., Chalmers, J. P., Perkovic, V., Chow, C., Li, Q., Jun, M., Neal, B., Zoungas, S., Poulter, N. R., Mancia, G., Williams, B., Sattar, N., & Woodward, M. (2014). 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. Diabetes Care, 37(1), 295 - 303. https://doi.org/10.2337/dc13-1165