Do cardiac biomarkers NT-proBNP and hsTnT predict microvascular events in patients With type 2 diabetes? Results from the ADVANCE Trial

Welsh, P. et al. (2014) Do cardiac biomarkers NT-proBNP and hsTnT predict microvascular events in patients With type 2 diabetes? Results from the ADVANCE Trial. Diabetes Care, 37(8), pp. 2202-2210. (doi:10.2337/dc13-2625)

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Publisher's URL: http://dx.doi.org/10.2337/dc13-2625

Abstract

OBJECTIVE We investigated microvascular event risk in people with type 2 diabetes and assessed whether N-terminal pro–B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hsTnT) improved prediction.

RESEARCH DESIGN AND METHODS We performed a case-cohort study, including 439 incident cases of microvascular events (new or worsening nephropathy or retinopathy) and 2,946 noncase subjects identified from participants in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. NT-proBNP and hsTnT were measured in stored plasma samples using automated commercial assays.

RESULTS After adjustment for age, sex, and randomized treatment, the hazard ratios for microvascular events per 1-SD increase in the log-transformed hsTnT and NT-proBNP were 1.67 (95% CI 1.51–1.85) and 1.63 (1.44–1.84), respectively. After further adjustment for classical and diabetes-related cardiovascular disease risk factors, the hazard ratios attenuated to 1.40 (1.24–1.58) and 1.41 (1.24–1.60), respectively. While the C statistic did not improve on addition of hsTnT or NT-proBNP for the total microvascular end point, a combination of both markers improved the prediction of nephropathy (P = 0.033) but not retinopathy (P = 0.72). The corresponding net reclassification indices in a three–risk category model (<10%, 10–15%, and >15% 5-year risk) for all microvascular events were 7.31% (95% CI 2.24–12.79) for hsTNT addition, 6.23% (1.74–11.5) for NT-proBNP addition, and 7.1% (1.5–12.9) for both markers together.

CONCLUSIONS These data suggest that cardiac biomarkers moderately improve microvascular event risk prediction, in particular the risk of nephropathy. Further studies examining the value of this approach for trial design and clinical use are warranted.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Welsh, Dr Paul and Sattar, Professor Naveed
Authors: Welsh, P., Woodward, M., Hillis, G. S., Li, Q., Marre, M., Williams, B., Poulter, N., Ryan, L., Harrap, S., Patel, A., Chalmers, J., and Sattar, N.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Diabetes Care
Publisher:American Diabetes Association
ISSN:0149-5992

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
612031Cardiac biomarkers and CVD risk screening: a cost-effective public health measure?Paul WelshBritish Heart Foundation (BHF)FS/12/62/29889RI CARDIOVASCULAR & MEDICAL SCIENCES