Journal article
Cardiac stress and inflammatory markers as predictors of heart failure in patients with type 2 diabetes: the ADVANCE trial
- Abstract:
-
Objective: This study examined the individual and combined impact of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hs-CRP) on the prediction of heart failure incidence or progression in patients with type 2 diabetes.
Research Design and Methods: A nested case-cohort study was conducted in 3,098 participants with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial.
Results: A higher value of each biomarker was significantly associated with a higher risk of heart failure incidence or progression, after adjustment for major risk factors. The hazard ratios per 1-SD increase were 3.06 (95% CI 2.37-3.96) for NT-proBNP, 1.50 (1.27-1.77) for hs-cTnT, 1.48 (1.27-1.72) for IL-6, and 1.32 (1.12-1.55) for hs-CRP. Addition of NT-proBNP to the model including conventional risk factors meaningfully improved 5-year risk predictive performance (c-statistic 0.8162 to 0.8800; continuous net reclassification improvement [NRI] 73.1%; categorical NRI [<5%, 5-10%, >10% 5-year risk] 24.2%). In contrast, addition of hs-cTnT, IL-6 or hs-CRP did not improve the prediction metrics consistently either in combination or when added to NT-proBNP.
Conclusions: Only NT-proBNP, strongly and consistently improved prediction of heart failure in patients with type 2 diabetes beyond a wide range of clinical risk factors and biomarkers.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
Actions
Access Document
- Files:
-
-
(Preview, Accepted manuscript, pdf, 835.5KB, Terms of use)
-
- Publisher copy:
- 10.2337/dc17-0509
Authors
+ National Health and Medical Research Council of Australia
More from this funder
- Funding agency for:
- Woodward, M
- Grant:
- Principal Research Fellow (1080206
- Publisher:
- American Diabetes Association
- Journal:
- Diabetes Care More from this journal
- Volume:
- 40
- Issue:
- 9
- Pages:
- 1203-1209
- Publication date:
- 2017-07-06
- Acceptance date:
- 2017-06-16
- DOI:
- EISSN:
-
1935-5548
- ISSN:
-
0149-5992
- Keywords:
- Pubs id:
-
pubs:701255
- UUID:
-
uuid:f03fab13-7c3c-421a-8efb-5dfbe57b428e
- Local pid:
-
pubs:701255
- Source identifiers:
-
701255
- Deposit date:
-
2017-06-19
Terms of use
- Copyright holder:
- American Diabetes Association
- Copyright date:
- 2017
- Notes:
- © 2017 by the American Diabetes Association. This is the accepted manuscript version of the article. The final version is available online from the American Diabetes Association at: [10.2337/dc17-0509]
If you are the owner of this record, you can report an update to it here: Report update to this record