Prognostic value of subclinical myocardial necrosis using high-sensitivity cardiac troponin T in patients with prediabetes

Abstract

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.

Assessing the risk factors for myocardial infarction in diet-induced prediabetes: myocardial tissue changes

“…In Table 1, we reported an insignificant negative association between HbA1c and the cardiac troponin (cTnT and cTnI) in the NPD group, whereas the association was positive in the PD group. This study is per a recently published study by Witkowski et al, in which prediabetes is associated with adverse cardiac events (MACE) and increasing hs-cTnT levels associated with an increased risk for 3-year MACE and 5-year all-cause mortality in the entire cohort [68].Interestingly, there was no correlation between the levels of hs-cTnT and either FBG or HbA1c [69]. Matsumoto observed a significant positive correlation between HbA1c and hs-cTnT in participants with T2DM.…”

High Sensitivity Cardiac Troponin T in Patients with Type 2 Diabetes Mellitus, Relation to Cardiac Metabolic Risk Factors: Hypertension and Truncal Obesity

“…Chronically elevated troponin levels are an elevated risk of cardiovascular events and a symptom of subclinical myocardial damage, overall mortality, and a number of illnesses, including (pre) diabetes (13,16) .…”

“…With a median level of 13 ng/L, Witkowski et al (13) showed that prediabetics had a high prevalence of hs-cTnT. Also, a greater risk of long-term unfavourable cardiovascular events was also demonstrated in stable prediabetic subjects with subclinical myocardial necrosis as determined by hs-cTnT.…”

“…Measuring hs-cTnT may reveal an underlying pathophysiologic overlap between CVD and diabetes that other common risk variables could miss. Participants with higher baseline hs-cTnT levels had a higher incidence of diabetes (12)(13) . In this study we aimed to evaluate the relation between high-sensitive cardiac troponin T and cardiac metabolic risks (hypertension and truncal obesity) in patient with T2DM.…”

Hypertension as One of the Main Non-Myocardial Infarction-Related Causes of Increased Cardiospecific Troponins: From Mechanisms to Significance in Current Medical Practice

“…an unfavorable prognosis [38][39][40][41]; 4) Diagnostic significance of CTs concentrations in urine and oral fluid (saliva) in case of CVDs [42][43][44][45][46][47]. This new field of noninvasive diagnostics and monitoring of CVDs has promising prospects due to a number of advantages associated with obtaining biomaterial.…”