Key result
In stable prediabetic subjects, elevated high-sensitivity cardiac troponin T levels were independently associated with an increased risk of major adverse cardiac events at 3 years (adjusted HR 2.42).
Why the study?
Risk stratification of patients with prediabetes remains an unmet clinical need.
Does elevated hs-cTnT predict MACE and mortality in stable subjects with prediabetes?
Cohort (n=2,631)
No
Does elevated hs-cTnT predict MACE and mortality in stable subjects with prediabetes?
Effect estimate: HR 2.42 (95% CI 1.69-3.46)
p-value: p=<0.001
Elevated hs-cTnT levels independently predict long-term MACE and all-cause mortality in stable patients with prediabetes, highlighting its potential for risk stratification.
May support hs-cTnT risk stratification in prediabetes; hypothesis-generating, requires prospective validation.
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.
No takes yet. Share an insight, caveat, or question.
Witkowski et al. (2021) conducted a cohort in Prediabetes (n=2,631). High-sensitivity cardiac troponin T (hs-cTnT) Quartile 4 (≥ 21.6 ng/L) vs. hs-cTnT Quartile 1 (< 8.2 ng/L) was evaluated on Major adverse cardiac events (MACE: death, myocardial infarction, stroke) at 3 years (HR 2.42, 95% CI 1.69-3.46, p=<0.001). In stable prediabetic subjects, elevated high-sensitivity cardiac troponin T levels were independently associated with an increased risk of major adverse cardiac events at 3 years (adjusted HR 2.42).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: