Abstract 17716: The Risk of Death in Relation to Traditional Markers of Target Organ Damage, Hs-troponin T, And NTproBNP, in Diabetics: The Atherosclerosis Risk in Communities (ARIC) Study
Background: Markers of diabetic end-organ damage, including retinopathy, peripheral arterial disease (PAD), cardiac dysfunction, and chronic kidney disease (CKD), are associated with an increased risk of death. We assessed the risk of death associated with traditional measures of organ damage, as well as hsTnT and NTproBNP, in diabetics free of cardiovascular disease (CVD) at baseline.
Methods: We evaluated 1390 middle-aged diabetic participants (mean age 63±6 yrs, 46% men, 32% African American) without prevalent clinical CVD (coronary disease, stroke, or heart failure) at visit 4 (1996-1998) in the ARIC Study. Traditional target organ damage was defined as the presence of retinopathy (≥1 sign of retinopathy according to established criteria), PAD (ABI1.4), ECG abnormalities (LV conduction defect, LV hypertrophy, ST-T abnormalities, atrial fibrillation), CKD (eGFR<60ml/min/1.73m2). Non-traditional markers of target organ damage included hs-TnT and NT-proBNP. We used multivariable Cox proportional hazards models to assess the association of these markers with the risk of death.
Results: Overall, 11% of the sample had retinopathy, 11% PAD, 19% ECG abnormalities, 4% CKD, 10% elevated hs-TnT (≥0.014 mcg/L), and 4% elevated NTproBNP (≥300 pg/ml). Over the follow-period (11±2 yrs), there were 220 deaths. In models adjusted for age, gender, race, and center, the presence of ECG abnormalities, CKD, elevated hsTnT, and NTproBNP were each associated with an increased risk of death, whereas retinopathy and PAD were not. In models adjusted for risk factors and all measures of target organ damage, only hsTnT was significantly associated with an increased risk of death (HR 1.98, 95% CI 1.35-2.89) (Table).
Conclusion: Among different markers of target organ damage, only subclinical myocardial injury, as reflected by elevated hsTnT, was independently associated with an increased risk of death in a community sample of diabetics without prevalent clinical CVD.
- © 2013 by American Heart Association, Inc.