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

Ohkuma, T. et al. (2017) Cardiac stress and inflammatory markers as predictors of heart failure in patients with type 2 diabetes: the ADVANCE trial. Diabetes Care, 40(9), pp. 1203-1209. (doi: 10.2337/dc17-0509) (PMID:28684396)

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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 study was 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 factors meaningfully 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.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Welsh, Professor Paul and Woodward, Professor Mark and Sattar, Professor Naveed
Authors: Ohkuma, T., Jun, M., Woodward, M., Zoungas, S., Cooper, M. E., Grobbee, D. E., Hamet, P., Mancia, G., Williams, B., Welsh, P., Sattar, N., Shaw, J. E., Rahimi, K., and Chalmers, J.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Diabetes Care
Publisher:American Diabetes Association
ISSN (Online):1935-5548
Published Online:06 July 2017
Copyright Holders:Copyright © 2017 The American Diabetes Association
First Published:First published in Diabetes Care 40(9):1203-1209
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
690421Glasgow Molecular Pathology (GMP) NodeKarin OienMedical Research Council (MRC)MR/N005813/1ICS - EXPERIMENTAL THERAPEUTICS