Abstract
Background and aimsWe aimed at comparing the impact of multiple non-traditional biomarkers (ankle brachial pressure index (ABI), N-terminal pro-brain natriuretic peptide (NT-proBNP), high sensitivity cardiac troponin (hs-cTnT), gamma-glutamyl transpeptidase (GGT) and four markers of systemic inflammation), both individually and in combination, on cardiovascular risk prediction, over and above traditional risk factors incorporated in the QRISK2 score, in older people with type 2 diabetes. MethodsWe conducted a prospective study of 1066 men and women aged 60–75 years with type 2 diabetes mellitus, living in Lothian, Scotland. ResultsAfter 8 years, 205 cardiovascular events occurred. Higher levels of hs-cTNT and NT-proBNP and lower ABI at baseline were associated with increased risk of CV events, independently of traditional risk factors (basic model). The C statistic of 0.722 (95% CI 0.681, 0.763) for the basic model increased on addition of individual biomarkers, most markedly for hs-cTnT (0.732; 0.690, 0.774)). Models including different combinations of biomarkers had even greater C statistics, with the highest for ABI, hs-cTnT and GGT combined (0.740; 0.699, 0.781). ConclusionsIndividually, hs-cTnT appeared to be the most promising biomarker in terms of improving vascular risk prediction in people with type 2 diabetes, over and above traditional risk factors incorporated in the QRISK2 score. Combining several non-traditional biomarkers added further predictive value, and this approach merits further investigation when developing cost effective risk prediction tools for use in clinical practice.
Highlights
The risk of cardiovascular (CV) disease is increased two-fold in people with type 2 diabetes [1]
In older people with type 2 diabetes, a number of individual non-traditional biomarkers were associated with increased risk of incident CV events, independent of factors currently used to predict CVD
This included higher levels of hs-cTnT and NT-proBNP and a lower ABI. hs-cTnT appeared to be the most promising individual biomarker in terms of improving risk prediction over-and-above traditional risk factors incorporated in the QRISK2 score
Summary
The risk of cardiovascular (CV) disease is increased two-fold in people with type 2 diabetes [1]. In the UK, the National Institute for Health and Care Excellence (NICE) clinical guidelines recommend the use of the QRISK2 score [2] to calculate 10-year CV risk; this score combines several traditional CV risk factors and has been validated in patients with and without type 2 diabetes [3]. We aimed at comparing the impact of multiple non-traditional biomarkers (ankle brachial pressure index (ABI), N-terminal pro-brain natriuretic peptide (NT-proBNP), high sensitivity cardiac troponin (hs-cTnT), gamma-glutamyl transpeptidase (GGT) and four markers of systemic inflammation), both individually and in combination, on cardiovascular risk prediction, over and above traditional risk factors incorporated in the QRISK2 score, in older people with type 2 diabetes. Conclusions: Individually, hs-cTnT appeared to be the most promising biomarker in terms of improving vascular risk prediction in people with type 2 diabetes, over and above traditional risk factors incorporated in the QRISK2 score. Combining several non-traditional biomarkers added further predictive value, and this approach merits further investigation when developing cost effective risk prediction tools for use in clinical practice
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