Cardiovascular Risk Prediction in Diabetes – Changes in the Prognostic Values of Modern Cardiovascular Biomarkers in Relation to Duration of Diabetes Mellitus

Background: Based on the complex pathophysiology of type 2 diabetes and atherosclerosis we hypothesized a dynamic change in prognostic value of cardiovascular biomarkers over time. Methods : In this prospective study 746 patients with type 2 diabetes mellitus, being followed up for 60 months were analysed. The primary endpoint was defined as unplanned hospitalization for cardiovascular disease or death. Beside others, especially the prognostic performance of the biomarkers of interest (GDF-15, NT-proBNP, hs-TnT) was evaluated in relation to quartiles of diabetesduration. Results: In patients having a diabetes duration below 7 years lnGDF-15 (HR 2.84; p < 0.01) and lnhs-TnT (HR 2.96; p<0.01) were significant predictors of the primary endpoint. LnAge (HR 40.11; p < 0.01) and lnNT-proBNP (HR 1.61; p <0.01) were significant predictors in patients with a diabetes duration between 7 and 12 years. In the third quartile (diabetes duration 12-22 years) lnAge (HR 13.09; p =0.041), urinary albumin to creatinine ratio (HR 2.74; p = 0.001) and lnNT-proBNP (HR 1.81, p < 0.001) predicted the endpoint. In patients with a diabetes duration above 22 years, lnAge (HR 50.79; p = 0.002) and lnNT-proBNP (HR 2.1; p < 0.01) were the only significant predictors of the endpoint. Conclusion: Prognostic power of cardiovascular biomarkers changes dynamically in relation to duration of type 2 diabetes mellitus. In patients with shorter duration of the disease markers of subclinical cardiovascular dysfunction and inflammation perform better than markers of systemic advanced organ dysfunction and cardiovascular disease.