High sensitivity cardiac troponin T and N-terminal pro-BNP predict cardiovascular events and death in patients with type 2 diabetes mellitus

Purpose: Current methods of risk-stratification in patients with type 2 diabetes mellitus (T2DM) are suboptimal. The current study assesses the ability of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high sensitivity cardiac troponin T (hs-cTnT) to improve the prediction of cardiovascular events and death in patients with T2DM. Methods: A nested case-cohort study was performed in patients with T2DM who participated in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. Results: In 3,862 patients with available samples, 709 (18%) experienced a major cardiovascular event (composite of cardiovascular death, non-fatal myocardial infarction or non-fatal stroke) and 706 (18%) died during a median of 5 years follow-up. In Cox regression models, adjusting for all established risk predictors, the hazard ratio [HR] for cardiovascular events for NT-proBNP was 1.94 per 1 standard deviation [SD] increase (95% confidence interval [CI] 1.72-2.19) and the HR for hs-cTnT was 1.52 per 1 SD increase (95% CI 1.38-1.67). The HRs for death were 1.97 (95% CI 1.74-2.23) and 1.54 (95% CI 1.39-1.70), respectively. The addition of either marker improved 5-year risk classification for cardiovascular events (net reclassification improvement in continuous model, 39% for NT-proBNP and 45% for hs-cTnT). Likewise, both markers greatly improved the accuracy with which the 5-year risk of death was predicted (table). The combination of both markers provided the best risk discrimination. View this table: Table 1. NT-proBNP and/or cTnT and 5 yr mortality Conclusion: NT-proBNP and hs-cTnT appear to remarkably improve the accuracy with which the risk of cardiovascular events or death can be estimated in patients with T2DM.