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High-Sensitivity Cardiac Troponin-T and N-Terminal Prohormone of B-Type Natriuretic Peptide in Relation to Cardiovascular Outcomes in Type 1 Diabetes

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posted on 21.09.2020 by Tina Costacou, Amy K. Saenger, Trevor J. Orchard
Objective: High-sensitivity cardiac Troponin-T (hs-cTnT) and N-terminal pro B-Type natriuretic peptide (NT-proBNP), biomarkers of cardiovascular disease (CVD) and heart failure, respectively, have not been widely studied in type 1 diabetes (T1D). We evaluated whether their assessment in T1D enhances the prediction of CVD and major atherosclerotic cardiovascular events (MACE).

Research Design and Methods: hs-cTnT and NT-proBNP were analyzed on the Roche Cobas E601 utilizing the first available stored specimen (n=581; mean age 29 and duration 21 years). CVD was defined as CVD death, myocardial infarction, coronary revascularization, angina, ischemia, or stroke and MACE as CVD death, myocardial infarction, or stroke.

Results: Median hs-cTnT (5.0 ng/L, IQR: <3.0, 10.0) was higher among men (p<0.0001), whereas median NT-proBNP (22.0 ng/L; 7.0, 61.0) did not differ by sex. In Cox models, log hs-cTnT (HR=1.38, p=0.0006) and log NT-proBNP (HR=1.24, p=0.0001) independently predicted CVD during 21 years of follow-up. However, their addition to models either singly or together did not significantly improve CVD prediction. Furthermore, a marginally significant sex interaction was observed (p=0.06), indicating that hs-cTnT’s prediction was limited to men. hs-cTnT and NT-proBNP also predicted MACE, although only NT-proBNP remained significant (HR=1.27, p=0.0009) when the biomarkers were included in a model simultaneously. Nonetheless, their addition to multivariable models did not enhance MACE prediction.

Conclusions: Sex differences were observed in the concentration and predictive ability of hs-cTnT and NT-proBNP in T1D. Overall, their addition to traditional risk factor models increased the area under the curve for neither CVD nor MACE.

Funding

This research was supported by NIH grant number DK34818 and the Rossi Memorial Fund. The assays for hs-cTnT and NT-proBNP were provided by Roche Diagnostics Corporation. Roche Diagnostics Corporation had input in neither the analysis of data nor the interpretation of results.

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