Cardiac stress and inflammatory markers as predictors of heart failure in patients with type 2 diabetes: The ADVANCE trial

Toshiaki Ohkuma, Min Jun, Mark Woodward, Sophia Zoungas, Mark E. Cooper, Diederick E. Grobbee, Pavel Hamet, Giuseppe Mancia, Bryan Williams, Paul Welsh, Naveed Sattar, Jonathan E. Shaw, Kazem Rahimi, John Chalmers, ADVANCE Collaborative Group

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)

Abstract

OBJECTIVE This study examined the individual and combined effect of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), interleukin-6 (IL-6), and hs-CRP on the prediction of heart failure incidence or progression in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS A nested case-cohort studywas conducted in 3,098 participants with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. RESULTS A higher value of each biomarker was significantly associated with a higher risk of heart failure incidence or progression, after adjustment for major risk factors. The hazard ratios per 1-SD increase were 3.06 (95% CI 2.37, 3.96) for NT-proBNP, 1.50 (1.27, 1.77) for hs-cTnT, 1.48 (1.27, 1.72) for IL-6, and 1.32 (1.12, 1.55) for hs-CRP. The addition of NT-proBNP to the model including conventional risk factorsmeaningfully improved 5-year risk-predictive performance (C statistic 0.8162 to 0.8800; continuous net reclassification improvement [NRI] 73.1%; categorical NRI [<5%, 5-10%, >10% 5-year risk] 24.2%). In contrast, the addition of hs-cTnT, IL-6, or hs-CRP did not improve the prediction metrics consistently in combination or when added to NT-proBNP. CONCLUSIONS Only NT-proBNP strongly and consistently improved the prediction of heart failure in patients with type 2 diabetes beyond a wide range of clinical risk factors and biomarkers.

Original languageEnglish
Pages (from-to)1203-1209
Number of pages7
JournalDiabetes Care
Volume40
Issue number9
DOIs
Publication statusPublished - 1 Sep 2017
Externally publishedYes

Keywords

  • Cardiac stress
  • Inflammatory markers
  • Heart failure
  • Type 2 diabetes
  • Biomarkers

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