Prognostic value of subclinical myocardial necrosis using high-sensitivity cardiac troponin T in patients with prediabetes.

Abstract

BACKGROUND:

Risk stratification of patients with prediabetes is an unmet clinical need. Here, we examine the utility of subclinical myocardial necrosis assessed by high-sensitivity cardiac troponin T (hs-cTnT) in predicting health outcomes in stable subjects with prediabetes.

METHODS:

hs-cTnT was analyzed by a high-sensitivity assay (Roche 5th generation) in 2631 stable subjects with prediabetes (HbA1c 5.7-6.4% or fasting glucose 100-125 mg/dL without previous diagnosis of diabetes or glucose-lowering therapy) who underwent elective coronary angiography for cardiac evaluation, and followed for major adverse cardiac events (MACE; death, myocardial infarction, stroke) over 3 years and all-cause mortality over 5 years.

RESULTS:

In our study cohort, hs-cTnT was highly prevalent with a median level of 13 ng/L (interquartile range 8.2-21.6 ng/L). Hs-cTnT was independently associated with incident MACE at 3 years (Q4 vs. Q1 adjusted hazard ratio (HR) 2.42 [95% CI 1.69-3.46], P < 0.001) and 5-year mortality (adjusted HR 3.8 [95% CI 2.55-5.67], P < 0.001). This association remained significant in all subsets after adjustment for traditional risk factors and multiple factors known to increase hs-cTnT levels. Moreover, hs-cTnT independently predicted event risk in primary prevention subjects (n = 557, HR 5.46 [95% CI 1.50-19.89), p < 0.01) for MACE; HR 9.53 [95% CI 2.08-43.73] for all-cause mortality) and secondary prevention subjects (n = 2074, HR 1.86 [95% CI 1.31-2.66], P < 0.001 for MACE; and 2.7 [95% CI 1.79-4.08), P < 0.001 for all-cause mortality).

CONCLUSIONS:

In stable prediabetic subjects, the presence of subclinical myocardial necrosis as detected by hs-cTnT portends heightened long-term adverse cardiovascular event risk. Hs-cTnT levels may help to stratify risk and improve clinical decision making in patients with prediabetes. Trial registration ClinicalTrials.gov Identifier: NCT00590200.

• Authors: Marco Witkowski, Yuping Wu, Stanley L Hazen, W H Wilson Tang
• Journal: Cardiovascular diabetology (Cardiovasc Diabetol) Vol. 20 Issue 1 Pg. 171 (08 21 2021) ISSN: 1475-2840 [Electronic] England
• PMID: 34419046 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © 2021. The Author(s).

Chemical References

• Biomarkers
• Troponin T

Topics

• Aged
• Aged, 80 and over
• Biomarkers (blood)
• Coronary Angiography
• Female
• Heart Disease Risk Factors
• Heart Diseases (blood, diagnostic imaging, mortality, pathology)
• Humans
• Male
• Middle Aged
• Myocardium (metabolism, pathology)
• Necrosis
• Ohio (epidemiology)
• Prediabetic State (diagnosis, epidemiology, mortality)
• Predictive Value of Tests
• Prognosis
• Prospective Studies
• Risk Assessment
• Time Factors
• Troponin T (blood)