Targeted multiple biomarker approach in predicting cardiovascular events in patients with diabetes

Autor: Anton Luger, Martin Clodi, Stephanie Neuhold, Richard Pacher, Christopher Adlbrecht, Martin Hülsmann, M Fritzer-Szekeres, Raphael Wurm, Guido Strunk, Greisa Vila, Michael Resl, Rudolf Prager
Rok vydání: 2016
Předmět:
Adult
Male
Oncology
medicine.medical_specialty
Growth Differentiation Factor 15
Time Factors
030209 endocrinology & metabolism
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
Risk Assessment
03 medical and health sciences
0302 clinical medicine
Troponin T
Predictive Value of Tests
Risk Factors
Diabetes mellitus
Internal medicine
Natriuretic Peptide
Brain
Prevalence
medicine
Clinical endpoint
Humans
Prospective Studies
Registries
Prospective cohort study
Aged
Proportional Hazards Models
Proportional hazards model
business.industry
Type 2 Diabetes Mellitus
Middle Aged
Prognosis
medicine.disease
Peptide Fragments
Up-Regulation
Hospitalization
Endocrinology
Diabetes Mellitus
Type 2
Cardiovascular Diseases
Austria
Predictive value of tests
Disease Progression
Biomarker (medicine)
Female
Cardiology and Cardiovascular Medicine
business
Biomarkers
Zdroj: Heart. 102:1963-1968
ISSN: 1468-201X
1355-6037
DOI: 10.1136/heartjnl-2015-308949
Popis: 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.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.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, p0.01, CI 1.12 to 1.68; loghs-TnT: HR 1.43, p0.01, CI 1.13 to 1.1.82; logNT-proBNP: HR 1.45, p0.01, 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%).GDF-15 and hs-TnT are strong independent cardiovascular biomarkers augmenting the predictive value of NT-proBNP in patients with diabetes.
Databáze: OpenAIRE
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