Elsevier

American Heart Journal

Volume 174, April 2016, Pages 43-50
American Heart Journal

Clinical Investigation
High-sensitive troponin T is associated with all-cause and cardiovascular mortality in stable outpatients with type 2 diabetes (ZODIAC-37)

https://doi.org/10.1016/j.ahj.2015.12.015Get rights and content

Background

We aimed to investigate whether high-sensitive cardiac troponin T (hs-cTnT) is associated with all-cause and cardiovascular mortality in stable type 2 diabetes (T2D) outpatients treated in primary care.

Methods

Cardiac troponin T was measured with a high-sensitive assay at baseline in patients with T2D participating in the observational ZODIAC study. Cox proportional hazards models were used to investigate the relationship between hs-cTnT and mortality with adjustment for selected confounders. Risk prediction capabilities of hs-cTnT were assessed with Harrell C statistics.

Results

Complete baseline data were available for 1,133 patients. During median follow-up of 11 (7-14) years, 513 (45%) patients died, of which 218 (42%) died of cardiovascular causes. Of the patients with undetectable hs-cTnT levels (<3 ng/L), only 23% died, compared with 58% with low detectable levels (3-14 ng/L) and 84% with raised levels (≥14 ng/L). Natural log hs-cTnT was significantly associated with all-cause mortality (hazard ratio 1.30, 95% CI 1.19-1.42) and cardiovascular mortality (hazard ratio 1.33, 95% CI 1.15-1.53), independent of potential confounders. The Harrell C statistic for the crude model of hs-cTnT was 0.72 (95% CI 0.70-0.75) for all-cause mortality and 0.74 (95% CI 0.71-0.77) for cardiovascular mortality.

Conclusions

Higher levels of hs-cTnT are associated with mortality in stable outpatients with T2D. The high crude Harrell C values and the excellent prognosis of patients with undetectable levels illustrate the strength of hs-cTnT as a potential marker for mortality.

Section snippets

Study group

The ZODIAC study was initiated in 1998, in the Zwolle region of the Netherlands. The design and details of this study have been published previously.14 In this study, general practitioners were assisted by hospital-based diabetes specialist nurses in their care of patients with T2D. In the first year, 1,143 patients with T2D were included in this prospective cohort study. In 2001, 545 patients with T2D enrolled in addition, leaving a combined cohort of 1,688 patients.15

Baseline serum cTnT

Results

Baseline characteristics of the study population are presented in Table I. At baseline, mean age of the total study population was 67 (12) years, 55% was female, and the median diabetes duration was 4 (2-9) years. A total of 523 (46%) patients had undetectable (<3 ng/L) concentrations of hs-cTNT, 443 (39%) patients had concentrations between 3 and 14 ng/L, and 167 (15%) patients had a concentration >14 ng/L. Patients with the highest hs-cTnT concentrations were older, were more frequently men,

Discussion

Serum hs-cTnT levels were independently associated with all-cause and cardiovascular mortality in outpatients with T2D. Patients with undetectable hs-cTnT had an excellent prognosis compared with patients with low detectable or increased levels. High-sensitive cTnT has no additive effect on risk prediction of all-cause and cardiovascular mortality on top of an extensive set of risk factors and other biomarkers. Nevertheless, the high discriminatory value of the crude and age- and

Conclusion

In conclusion, higher levels of hs-cTnT were associated with increased all-cause and cardiovascular mortality in patients with T2D. The high discrimination property of hs-cTnT alone and the excellent prognosis of patients with undetectable levels illustrate the strength of hs-cTnT as a potential complementary marker for (cardiovascular) mortality.

The following is the supplementary data related to this article.

. Subgroup analysis for men and women.

Conflicts of interest

None.

Author contributions

S.H.H., P.R.D., K.J.J.H., S.J.L.B., G.W.D.L., H.J.G.B., and N.K. designed the study. K.J.J.H., L.J.P., and G.W.D.L. acquired the data. S.H.H., P.R.D., K.J.J.H., G.W.D.L., and N.K. analyzed the data. S.H.H. and P.R.D. drafted the manuscript. K.J.J.H., L.J.P., K.H.G., H.J.G.B., S.J.L.B., G.W.D.L., and N.K. reviewed and edited the manuscript. All authors read and approved the final manuscript. S.H.H. is the guarantor of this work and, as such, had full access to all the data in the study and takes

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