Cardiac troponins refine risk profile of older adults with diabetes
medwireNews: Measuring high-sensitivity cardiac troponins (hs-cTn) I and T can help to refine mortality risk prediction in older adults with diabetes and different levels of comorbidity burden, research shows.
“The use of objective biomarkers may address the lack of a uniform objective approach to assessing and incorporating comorbidity burden in treatment guidance,” write Elizabeth Selvin (Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA) and study co-authors in Diabetes Care.
The team studied 1835 people, aged 67–89 years (43% male, 31% Black), who had diabetes and were examined in 2011–2013 as part of the ARIC study. Of these people, 61% had a high comorbidity burden, having at least three comorbidities, most commonly hypertension, arthritis, and chronic kidney disease.
During a median 6.2 years of follow-up, 418 people died. Death was more likely among people with high versus low levels of cardiac troponins, with 4-year cumulative mortality rates for the 85th and above versus below the 40th percentiles being 27.8% versus 5.4% for hs-cTnI and 29.4% versus 5.4% for hs-cTnT.
Having a high comorbidity burden was also associated with an increased risk for death, and this factor significantly improved the accuracy of a baseline predictive model based on variables including age, sex, smoking status, blood pressure, lipid profile, medication use, and glycated hemoglobin.
But adding hs-cTnI or hs-cTnT as continuous variables further improved this model, increasing the C-statistic from 0.7024 to 0.7243 or 0.7344, respectively.
“The improvement in risk stratification using hs-cTnI or hs-cTnT appeared to be concentrated in downstratifying the risk among those who did not die as opposed to upstratifying the predicted risk for mortality among those who did die,” the researchers observe.
“This suggests that among older adults with diabetes, low hs-cTnI or hs-cTnT identifies the group that is at lower mortality risk, potentially reflecting better overall cardiovascular health.”
They stress that cardiac troponin measurement and comorbidity burden should be considered in conjunction. People with a high comorbidity burden plus high cardiac troponin levels had the highest overall mortality risk, and those with neither had the lowest. But there was also an intermediate group formed of people with high cardiac troponin levels and a low comorbidity burden or with low cardiac troponin levels and a high comorbidity burden.
“In this population, despite its age and multimorbidity, hs-cTnI or hs-cTnT might identify older patients with longer life expectancy and greater potential to benefit from more aggressive treatment of cardiovascular risk factors, such as more stringent glycemic control,” conclude Selvin and team.
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