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