January 1, 2010Open Access
Determinants and prognostic implications of Cardiac Troponin T measured by a sensitive assay in Type 2 Diabetes Mellitus
Key Result
High-sensitivity cardiac troponin T was detectable in 90% of patients with type 2 diabetes and elevated above the 99th percentile in 18%, with higher levels showing a trend toward increased hospitalizations.
Study Design
Type
Observational (n=124)
Blinding
Blinded
Multicenter
No
Structured PICO
Does multifactorial intensive diabetes care reduce high-sensitivity cardiac troponin T levels compared to conventional care, and do baseline cTnT levels predict hospitalizations in patients with Type 2 Diabetes Mellitus?
P
Population
124 patients with type 2 diabetes mellitus, free of clinically significant peripheral or cerebral artery disease, followed for 2 years to assess the prognostic implications of high-sensitivity cardiac troponin T.
E
Exposure
Multifactorial intensive diabetes care for lowering cardiovascular risk
C
Comparator
Conventional diabetes care
O
Outcome
Prevalence, determinants, and prognostic implications (hospitalizations) of cardiac troponin T (cTnT) elevations measured with a high-sensitivity assay at baseline and 2-year follow-upsurrogate
High-sensitivity cardiac troponin T is frequently elevated in patients with Type 2 Diabetes Mellitus, correlates with conventional cardiovascular risk factors, and shows a trend toward predicting future hospitalizations.
Main Result
p-value: p=0.058
Limitations
- Post hoc design restricts interpretation.
- Hospitalizations were only classified as all-cause or diabetes/CV-related, not specifically CV hospitalizations.
- Adjustments for relevant covariates were not possible due to the low number of patients and endpoints.
- Baseline and 2-year samples were measured at different time-points, increasing analytical variability.
Abstract
BACKGROUND: The cardiac troponins are biomarkers used for diagnosis of myocardial injury. They are also powerful prognostic markers in many diseases and settings. Recently introduced high-sensitivity assays indicate that chronic cardiac troponin elevations are common in response to cardiovascular (CV) morbidity. Type 2 diabetes mellitus (T2DM) confers a high risk of CV disease, but little is known about chronic cardiac troponin elevations in diabetic subjects. Accordingly, we aimed to understand the prevalence, determinants, and prognostic implications of cardiac troponin T (cTnT) elevations measured with a high-sensitivity assay in patients with T2DM. METHODS: cTnT was measured in stored, frozen serum samples from 124 subjects enrolled in the Asker and Bærum Cardiovascular Diabetes trial at baseline and at 2-year follow-up, if available (96 samples available). Results were analyzed in relation to baseline variables, hospitalizations, and group assignment (multifactorial intensive versus conventional diabetes care for lowering CV risk). RESULTS: One-hundred thirteen (90%) had detectable cTnT at baseline and of those, 22 (18% of the total population) subjects had values above the 99th percentile for healthy controls (13.5 ng/L). Levels at baseline were associated with conventional CV risk factors (age, renal function, gender). There was a strong correlation between cTnT levels at the two time-points (r=0.92, p>0.001). Risk for hospitalizations during follow-up increased step-wise by quartiles of hscTnT measured at baseline (p=0.058). CONCLUSIONS: Elevations of cTnT above the 99th percentile measured by a highly sensitive assay were encountered frequently in a population of T2DM patients. cTnT levels appeared to be stable over time and associated with conventional CV risk factors. Although a clear trend was present, no statistically robust associations with adverse outcomes could be found.