Abstract 16: Diabetes, Pre-diabetes, and Progression of Subclinical Myocardial Damage
Background: Persons with hyperglycemia even below the threshold for the diagnosis of diabetes are at increased risk for cardiovascular events. The relationships of pre-diabetes and undiagnosed diabetes with progression of subclinical myocardial damage are relatively uncharacterized.
Objective: To characterize the associations of diabetes and pre-diabetes with 6-year progression of subclinical myocardial injury, as assessed by a novel highly sensitive assay for cardiac troponin T (hs-cTnT).
Methods: We conducted a prospective analysis of hs-cTnT measured at two time points, 6 years apart, in 8446 participants of the community-based ARIC Study with hs-cTnT <14 ng/L and without a history of heart disease, stroke or heart failure at baseline (1990-92). We examined the associations of pre-diabetes and diabetes defined by HbA1c or fasting glucose with 6-year change in hs-cTnT after adjustment for traditional cardiovascular risk factors. Diagnosed diabetes was defined as self-reported physician diagnosis or medication use for diabetes. We used Poisson regression to evaluate the risk of progression of hs-cTnT from non-elevated (<14 ng/L) to elevated (≥14 ng/L) (“incident elevated hs-cTnT”) at 6 years of follow-up.
Results: Baseline prevalence of elevated concentrations of hs-cTnT among persons with no diabetes (HbA1c<5.7%), prediabetes (HbA1c 5.7-6.4%), undiagnosed diabetes (≥6.5%), and diagnosed diabetes were 1.8%, 3.3%, 6.3% and 10.3%, respectively. Diagnosed diabetes, undiagnosed diabetes, and pre-diabetes were significantly associated with incident elevated hs-cTnT (Table). The associations of undiagnosed diabetes and pre-diabetes defined by diagnostic categories of HbA1c showed somewhat stronger associations compared to those clinical categories defined by fasting glucose.
Conclusions: These results provide evidence for a progressive, deleterious effect of hyperglycemia on the myocardium, even below the threshold for a diagnosis of diabetes.
Author Disclosures: E. Selvin: B. Research Grant; Significant; NIDDK grant R01 DK089174 to Dr. Selvin. C. Other Research Support; Significant; Roche Diagnostics provided material support (kits only; not funds were provided) for the high-sensitivity cardiac troponin assays.. M. Lazo: None. L. Shen: None. J. Rubin: None. J. McEvoy: None. R.C. Hoogeveen: B. Research Grant; Significant; Dr. Hoogeveen has received grant support from Roche Diagnostics and is a co-investigator on a provisional patent filed by Roche for use of biomarkers in heart failure prediction. C.M. Ballantyne: B. Research Grant; Significant; Dr. Ballantyne has received grant support from Roche Diagnostics and is a co-investigator on a provisional patent filed by Roche for use of biomarkers in heart failure prediction.. J. Coresh: None.
- © 2014 by American Heart Association, Inc.