Detectable subclinical myocardial necrosis is associated with cardiovascular risk in stable patients with diabetes.

Abstract

OBJECTIVE:

To investigate the relationship between different degrees of subclinical myocardial necrosis, glycemic control, and long-term adverse clinical outcomes within a stable patient population with diabetes mellitus.

RESEARCH DESIGN AND METHODS:

We examined 1,275 stable patients with diabetes mellitus undergoing elective diagnostic coronary angiography with cardiac troponin I (cTnI) levels below the diagnostic cut-off for defining myocardial infarction (MI) (<0.03 ng/mL). The relationship of subclinical myocardial necrosis (cTnI 0.009-0.029 ng/mL) with incident major adverse cardiovascular events (MACE; defined as any death, MI, or stroke) over 3 years of follow-up was examined.

RESULTS:

Subclinical myocardial necrosis was observed in 22% of patients. A strong association was observed between the magnitude of subclinical myocardial necrosis and risk of 3-year incident MACE (hazard ratio, 1.98; 95% confidence interval, 1.48-2.65; P < 0.001) and remained statistically significant even after adjustment for traditional risk factors, high-sensitivity C-reactive protein, and creatinine clearance. Only a weak correlation was observed between the presence of subclinical myocardial necrosis and either glycemic control (r = 0.06; P = 0.044 for hemoglobin A1c versus cTnI) or insulin resistance (r = 0.04; P = 0.094 for glucose-to-insulin ratio versus cTnI).

CONCLUSIONS:

The presence of detectable subclinical myocardial necrosis in stable patients with diabetes mellitus is associated with heightened long-term risk for MACE, independent of traditional risk factors and glycemic control.

• Authors: W H Wilson Tang, Yuping Wu, Earl B Britt Jr, Naveed Iqbal, Stanley L Hazen
• Journal: Diabetes care (Diabetes Care) Vol. 36 Issue 5 Pg. 1126-31 (May 2013) ISSN: 1935-5548 [Electronic] United States
• PMID: 23393213 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Blood Glucose
• Troponin I
• C-Reactive Protein

Topics

• Aged
• Blood Glucose (metabolism)
• C-Reactive Protein (metabolism)
• Cardiovascular Diseases (blood, metabolism)
• Diabetes Mellitus (blood, physiopathology)
• Female
• Humans
• Male
• Middle Aged
• Myocardial Infarction (blood, metabolism)
• Risk Factors
• Troponin I (blood)