Clinical InvestigationHigh-sensitive troponin T is associated with all-cause and cardiovascular mortality in stable outpatients with type 2 diabetes (ZODIAC-37)
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.
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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2020, Clinica Chimica ActaCitation Excerpt :Hendriks et al. evaluated the association between hs-cTnT and mortality in patients with T2DM stratifying the population study according to hs-cTnT levels. The authors found that hs-cTnT was associated to both cardiovascular and all-cause mortality in a model adjusted for the main confounding factors and the strength of this association was higher in the group of patients with the highest hs-cTnT values than in the other groups [57]. Interestingly, most of the studies in this field has evaluated hs-cTnT, while very few studies have focused on hs-cTnI and cardiovascular outcomes in persons with T2DM, especially in the setting of primary prevention.
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