American Diabetes Association
ELIXA_Biomarker_Paper_Supplement_--_April_27_Novel_Communication_Clean.pdf (533.3 kB)

Protein Biomarkers and Cardiovascular Outcomes in People with Type 2 Diabetes and Acute Coronary Syndrome: The ELIXA Biomarker Study

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posted on 2022-07-11, 22:30 authored by Hertzel C. Gerstein, Sibylle Hess, Brian Claggett, Kenneth Dickstein, Lars Kober, Aldo Pietro Maggioni, John J.V. McMurray, Jeffrey L. Probstfield, Matthew C. Riddle, Jean-Claude Tardif, Marc A. Pfeffer


Background: Protein biomarkers may identify people with type 2 diabetes at high risk of cardiovascular outcomes and death. 

Methods:  Bio-banked serum from 4957 ELIXA (Evaluating Lixisenatide in Acute Coronary Syndrome) participants was analyzed. Forward-selection Cox models identified independent protein risk factors for major adverse cardiovascular events (MACE) and death, that were compared to a previously validated biomarker panel. 

Results: NT-proBNP and osteoprotegerin predicted both outcomes. In addition, trefoil factor 3 predicted MACE, and angiopoietin-2 predicted death (C = 0.70 and 0.79 respectively compared to 0.63 and 0.66 for clinical variables alone). These proteins had all been previously identified and validated. Notably, C statistics for just NT-proBNP plus clinical risk factors were 0.69 and 0.78 for MACE and death respectively. 

Conclusion: NT-proBNP and other proteins independently predict CV outcomes in people with type 2 diabetes following acute coronary syndrome. Adding other biomarkers only marginally increased NT-proBNP’s prognostic value.  


The ELIXA trial as well as the ELIXA biomarker substudy was funded by Sanofi.


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