Distribution and prognostic value of high-sensitive troponin T measurement in patients with type 2 diabetes without cardiovascular disease.

Abstract Aim The objective of this work was to define a value for the 99th percentile of high-sensitive troponin T and to evaluate the prognostic value of this biomarker in a population of patients with type 2 diabetes without a history of cardiovascular disease. Methods In this prospective, observational and analytic study, 482 patients with type 2 diabetes were enrolled. The patients were asymptomatic, with no history of cardiovascular events, renal insufficiency, or inflammatory or systemic disease. As events we considered a combined end point of major adverse cardiovascular events (MACE). Results 94.9% of the patients had detectable troponin values, 20.7% of the patients had troponin values above the healthy population reference upper threshold (14 pg/mL). The 99th percentile value for this patient population was 48 pg/mL. Age, sex, the glomerular filtration rate and hypertension were associated with troponin values > 14 pg/mL. The incidence of MACE was 3.96 per 100 patients/year (p/y) between those with hs-TnT > 14 pg/mL and 1.07 per 100 p/y between those with hs-TnT ≤ 14 pg/mL (HR = 3.78 CI95 1.49–9.58; p = 0.005). Conclusions The 99th percentile value of troponin T in a population of patients with type 2 diabetes is 3-fold higher than the value proposed by the manufacturer for a healthy population. We also observed a significant difference in the distribution of troponin T values between men and women. This biomarker may be a valuable prognostic factor, since troponin T values above the reference upper threshold were associated with an increase in the risk of cardiovascular events in these patients.