Aging and Diabetes: Shifting the Risk Trajectory With High-Sensitivity Cardiac Troponins.

Diabetes is a serious health challenge for the aging population, contributing to morbidity and mortality primarily through increased risk for ischemic heart disease, heart failure, and stroke (1). Approximately 25–30% of adults over the age of 65 years have diabetes (2,3), and this proportion is expected to increase rapidly in the coming decades (4). Older individuals with diabetes also have higher rates of comorbidities including functional disability, accelerated muscle loss, chronic kidney disease, and coexisting cardiovascular risk factors compared with those without diabetes (3). Since multiple comorbidity among older adults with diabetes is common, individualized risk assessment to guide therapy using standard risk stratification tools has proven to be challenging. Therefore, new strategies are needed to improve risk assessment and inform use of novel and emerging therapies for patients with diabetes given important risk/benefit trade-offs between efficacy and adverse effects in the older adult population. Incorporation of high-sensitivity cardiac troponin (hs-cTn) into risk stratification and treatment decision algorithms is one such strategy that has the potential to improve personalized diabetes care. hs-cTn–based risk stratification (using both the hs-cTnT and hs-cTnI isoforms) has been extensively investigated in multiple population settings and for multiple outcomes including coronary artery disease, heart failure, stroke, and mortality (5–8). The association is strongest for heart failure and mortality and weakest for ischemic events (6). When measured in ambulatory individuals without cardiac symptoms, hs-cTn is a measure of subclinical myocardial injury and provides independent, additional prognostic information beyond other cardiac biomarkers and diagnostic tests such as electrocardiographic left ventricular hypertrophy, N-terminal pro B-type natriuretic peptide, and coronary artery calcium (9,10). Importantly, although hs-cTn is commonly elevated beyond the detectable threshold in older adults (∼2/3 will have a level …