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 S. Hillis1⇑,
- Paul Welsh2,
- John Chalmers1,
- Vlado Perkovic1,
- Clara K. Chow1,
- Qiang Li1,
- Min Jun1,
- Bruce Neal1,
- Sophia Zoungas3,
- Neil Poulter4,
- Giuseppe Mancia5,
- Bryan Williams6,
- Naveed Sattar2 and
- Mark Woodward1
- 1The George Institute for Global Health, University of Sydney, Sydney, Australia
- 2Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K.
- 3School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- 4International Centre for Circulatory Health, Imperial College London, London, U.K.
- 5Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milan, Italy
- 6University College London, London, U.K.
- Corresponding author: Graham S. Hillis, .
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 NT-proBNP and 46% for hs-cTnT). Likewise, both markers greatly improved the accuracy with 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.
N.S. and M.W. are joint senior authors.
This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc13-1165/-/DC1.
- Received May 15, 2013.
- Accepted August 14, 2013.
- © 2014 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. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.