M Resl1,2, M Clodi2, G Vila1, A Luger1, S Neuhold3, R Wurm4, C Adlbrecht4, G Strunk5,6, M Fritzer-Szekeres7, R Prager8, R Pacher4, M Hülsmann4. 1. Division of Endocrinology, Department of Medicine III, Medical University of Vienna, Vienna, Austria. 2. Department of Medicine, St. John of God's Hospital Linz, Institute for Cardiometabolic Research JKU, Linz, Austria. 3. Department of Medicine IV, Kaiser Franz Joseph Spital, Vienna, Austria. 4. Division of Cardiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria. 5. Technical University Dortmund, Germany. 6. FH Campus Vienna and Complexity Research, Vienna, Austria. 7. Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria. 8. Karl Landsteiner Institute for Nephrology and Diabetes, Hietzing Hospital Vienna, Vienna, Austria.
Abstract
OBJECTIVE: We hypothesised that biomarkers representing different pathophysiological pathways of atherosclerosis namely growth differentiation factor 15 (GDF-15), N-terminal pro B-type natriuretic peptide (NT-proBNP) and high-sensitive troponin T (hs-TnT) could enhance cardiovascular risk prediction in patients with type 2 diabetes mellitus. METHODS: This is a prospective study in 746 patients with type 2 diabetes mellitus, who were followed up for 60 months. The primary endpoint was defined as unplanned hospitalisation for cardiovascular disease or death. The prognostic performance of the biomarkers of interest (GDF-15 in comparison with NT-proBNP and hs-TnT) was evaluated in univariate as well as in stepwise Cox regression models. HRs are presented per standard unit increase. RESULTS: The primary endpoint was registered in 171 patients (22.9%). In univariate Cox regression models, GDF-15 as well as hs-TnT provided significant prognostic information. Even after adjusting for established cardiovascular risk factors, GDF-15, hs-TnT and NT-proBNP remained strong independent predictors of the endpoint (logGDF-15: HR 1.37, p<0.01, CI 1.12 to 1.68; loghs-TnT: HR 1.43, p<0.01, CI 1.13 to 1.1.82; logNT-proBNP: HR 1.45, p<0.01, CI 1.26 to 1.66). The number of elevated markers showed a strong complementarity to predict future long-term risk. Adding hs-TnT and GDF-15 to a zero model already including NT-proBNP led to a net reclassification improvement (NRI) of 33.6% (CI 16.0% to 50.8%, NRI for patients with event: 11.1% CI -4.7% to 26.6%, for patients without event: 22.5% CI 13.6% to 30.5%). CONCLUSIONS: GDF-15 and hs-TnT are strong independent cardiovascular biomarkers augmenting the predictive value of NT-proBNP in patients with diabetes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
OBJECTIVE: We hypothesised that biomarkers representing different pathophysiological pathways of atherosclerosis namely growth differentiation factor 15 (GDF-15), N-terminal pro B-type natriuretic peptide (NT-proBNP) and high-sensitive troponin T (hs-TnT) could enhance cardiovascular risk prediction in patients with type 2 diabetes mellitus. METHODS: This is a prospective study in 746 patients with type 2 diabetes mellitus, who were followed up for 60 months. The primary endpoint was defined as unplanned hospitalisation for cardiovascular disease or death. The prognostic performance of the biomarkers of interest (GDF-15 in comparison with NT-proBNP and hs-TnT) was evaluated in univariate as well as in stepwise Cox regression models. HRs are presented per standard unit increase. RESULTS: The primary endpoint was registered in 171 patients (22.9%). In univariate Cox regression models, GDF-15 as well as hs-TnT provided significant prognostic information. Even after adjusting for established cardiovascular risk factors, GDF-15, hs-TnT and NT-proBNP remained strong independent predictors of the endpoint (logGDF-15: HR 1.37, p<0.01, CI 1.12 to 1.68; loghs-TnT: HR 1.43, p<0.01, CI 1.13 to 1.1.82; logNT-proBNP: HR 1.45, p<0.01, CI 1.26 to 1.66). The number of elevated markers showed a strong complementarity to predict future long-term risk. Adding hs-TnT and GDF-15 to a zero model already including NT-proBNP led to a net reclassification improvement (NRI) of 33.6% (CI 16.0% to 50.8%, NRI for patients with event: 11.1% CI -4.7% to 26.6%, for patients without event: 22.5% CI 13.6% to 30.5%). CONCLUSIONS:GDF-15 and hs-TnT are strong independent cardiovascular biomarkers augmenting the predictive value of NT-proBNP in patients with diabetes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Authors: Axel C Carlsson; Christoph Nowak; Lars Lind; Carl Johan Östgren; Fredrik H Nyström; Johan Sundström; Juan Jesus Carrero; Ulf Riserus; Erik Ingelsson; Tove Fall; Johan Ärnlöv Journal: Ups J Med Sci Date: 2019-12-05 Impact factor: 2.384
Authors: Suyi Xie; Qi Li; Andrea O Y Luk; Hui-Yao Lan; Paul K S Chan; Antoni Bayés-Genís; Francis K L Chan; Erik Fung Journal: Biomolecules Date: 2022-07-04
Authors: Patrícia Lourenço; Filipe M Cunha; João Ferreira-Coimbra; Isaac Barroso; João-Tiago Guimarães; Paulo Bettencourt Journal: ESC Heart Fail Date: 2021-05-02
Authors: Marie Frimodt-Møller; Bernt Johan von Scholten; Henrik Reinhard; Peter Karl Jacobsen; Tine Willum Hansen; Frederik Ivar Persson; Hans-Henrik Parving; Peter Rossing Journal: PLoS One Date: 2018-04-26 Impact factor: 3.240