Abstract 356: Effect of Treatment with Rosiglitazone on High-sensitivity Cardiac Troponin Levels Among Patients with Type 2 Diabetes Mellitus

Abstract

Background: Rosiglitazone has been associated with increased risk of adverse cardiovascular events, including myocardial infarction (MI) and heart failure. However, the impact of rosiglitazone on markers of subclinical myocardial injury, such as high-sensitivity cardiac troponin-T levels (hscTnT), is not known. Objective: Evaluate the impact of intermediate-term treatment with rosiglitazone on hscTnT levels among patients with T2DM with or at high risk for coronary artery disease (CAD). Methods: We measured serum hscTnT levels at baseline and after 6 months of study treatment in a randomized trial comparing rosiglitazone versus placebo in patients with T2DM and risk factors for or prevalent CAD. Multivariable adjusted linear regression analysis was performed to identify variables associated with changes in hsTnT levels from baseline to follow up. Results: The study included 150 participants, of whom 106 had paired baseline and end-of-study blood samples for analysis (53 placebo, 53 rosiglitazone, mean age 56 + 8 years, 42% women; 8.8 years average T2DM duration; 42% insulin treated). Almost all study participants (93%) had elevated hscTnT (≥3 ng/L) at baseline; 23% had hscTnT levels exceeding the diagnostic limit commonly used to diagnose MI (≥14 ng/L). As expected, age, male sex and left ventricular hypertrophy were independently associated with elevated hscTnT levels at baseline. HscTnT levels increased from baseline to follow up within both the placebo and rosiglitazone treated groups (Figure), with no difference between the two groups after 6 months (p =0.73). In multivariable adjusted linear regression analysis, male sex (β = 0.36; p= 0.04), baseline hemoglobin A1c (β= 0.43; p= 0.001) and baseline hscTnT levels (β= -0.69; p <0.0001) were independently associated with an increase in hscTnT from baseline to follow-up. Use of rosiglitazone was not associated with an increase in hscTnT levels in the adjusted model (p = 0.65). Conclusion: There is high prevalence of elevated hscTnT among patients with T2DM with prevalent or clustered risk factors for CAD, exceeding the MI detection limit in almost a quarter of such patients. Rosiglitazone did not impact hscTnT levels, adding to the growing body of literature suggesting that rosiglitazone is not associated with direct myocardial injury.