Prognostic value of subclinical myocardial necrosis using high-sensitivity cardiac troponin T in patients with prediabetes

Marco Witkowski,W H Wilson Tang,Stanley L Hazen,Yuping Wu

doi:10.1186/s12933-021-01365-9

Abstract

BackgroundRisk stratification of patients with prediabetes is an unmet clinical need. Here, we examine the utility of subclinical myocardial necrosis assessed by high-sensitivity cardiac troponin T (hs-cTnT) in predicting health outcomes in stable subjects with prediabetes.Methodshs-cTnT was analyzed by a high-sensitivity assay (Roche 5th generation) in 2631 stable subjects with prediabetes (HbA1c 5.7–6.4% or fasting glucose 100–125 mg/dL without previous diagnosis of diabetes or glucose-lowering therapy) who underwent elective coronary angiography for cardiac evaluation, and followed for major adverse cardiac events (MACE; death, myocardial infarction, stroke) over 3 years and all-cause mortality over 5 years.ResultsIn our study cohort, hs-cTnT was highly prevalent with a median level of 13 ng/L (interquartile range 8.2–21.6 ng/L). Hs-cTnT was independently associated with incident MACE at 3 years (Q4 vs. Q1 adjusted hazard ratio (HR) 2.42 [95% CI 1.69–3.46], P < 0.001) and 5-year mortality (adjusted HR 3.8 [95% CI 2.55–5.67], P < 0.001). This association remained significant in all subsets after adjustment for traditional risk factors and multiple factors known to increase hs-cTnT levels. Moreover, hs-cTnT independently predicted event risk in primary prevention subjects (n = 557, HR 5.46 [95% CI 1.50–19.89), p < 0.01) for MACE; HR 9.53 [95% CI 2.08–43.73] for all-cause mortality) and secondary prevention subjects (n = 2074, HR 1.86 [95% CI 1.31–2.66], P < 0.001 for MACE; and 2.7 [95% CI 1.79–4.08), P < 0.001 for all-cause mortality).ConclusionsIn stable prediabetic subjects, the presence of subclinical myocardial necrosis as detected by hs-cTnT portends heightened long-term adverse cardiovascular event risk. Hs-cTnT levels may help to stratify risk and improve clinical decision making in patients with prediabetes.Trial registration ClinicalTrials.gov Identifier: NCT00590200.

Highlights

Prediabetes, defined as glycemic concentrations above normal but lower than diabetes thresholds, has emerged as a new category of abnormal glycemic control
Many studies report that prediabetes does not portend the same increase in cardiovascular disease (CVD) risk as seen in diabetes and association of prediabetes with cardiovascular complications are inconsistent throughout multiple studies both in the general population [4,5,6,7,8] as well as secondary prevention subjects [9,10,11]
We and others have previously shown that high-sensitivity cardiac troponin T (hs-cTnT) is associated with major adverse cardiac events (MACE) in patients with diabetes [14] and that prediabetes is independently associated with incident of subclinical myocardial necrosis (SMN) and CVD risk in community-based populations [6, 15]

Summary

Introduction

Prediabetes, defined as glycemic concentrations above normal but lower than diabetes thresholds, has emerged as a new category of abnormal glycemic control. Since the availability of high-sensitivity cardiac troponin T (hs-cTnT) assays, the prognostic utility of subclinical myocardial necrosis (SMN) has gained growing appreciation in their ability to predict adverse long-term cardiovascular risk in stable cardiovascular patients [12, 13]. We examined the clinical prognostic utility of hs-cTnT in both primary and secondary prevention subjects as a biomarker to identify prediabetic subjects at increased cardiovascular risk and appropriate for more aggressive preventive efforts. We examine the utility of subclinical myocardial necrosis assessed by high-sensitivity cardiac troponin T (hs-cTnT) in predicting health outcomes in stable subjects with prediabetes

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