Prognostic and comparative performance of cardiovascular risk markers in patients with type 2 diabetes.

BACKGROUND Diagnostic tests including echocardiography, albuminuria, electrocardiogram (ECG), high sensitivity troponin I (hs-TnI) and NT-pro brain natriuretic peptide (NT-proBNP), have been suggested as cardiovascular risk predictors in type 2 diabetes. We studied the separate and combined prognostic yield of these risk markers. METHODS In all, 1,030 type 2 diabetes patients were recruited from specialized clinics in this prospective cohort study. Full echocardiographic evaluation was feasible in 886 patients in sinus rhythm with adequate image quality. ECG was performed in 998 patients. Albuminuria was measured in 1,009 and NT-proBNP/hs-TnI in 933. The end-point was a composite of CV events. RESULTS The median follow-up was 4.7 years (interquartile range: 4.0 to 5.3) and 174 patients experienced a CVD event. All considered markers except hs-TnI were significantly (p 150 pg/ml): 3.05 (2.11-4.40) and hs-TnI: 1.12 (0.79-1.59). After adjusting for clinical variables, all remained significantly associated with the end-point. However, after adjusting for each other, only NT-proBNP>150 pg/ml remained significantly associated with the end-point (2.07 (1.28-3.34), p<0.001). Measured by C-statistics, model performance was highest with log2 (NT-proBNP) (0.70 (0.65-0.75)) and similar to clinical variables alone (0.71 (0.67-0.76)). Combining all risk markers only resulted in very limited increase in C-statistics (0.69 (0.64-0.74)). CONCLUSIONS This study identified NT-proBNP over echocardiography, ECG and albuminuria in risk prediction in type 2 diabetes patients. The diagnostic yield in considering more than one risk marker was limited in this population. This article is protected by copyright. All rights reserved.