Abstract 15078: Effects of Glucose Control and Coronary Revascularization Strategies on Cardiac Troponin and Natriuretic Peptide Levels in Patients with Type 2 Diabetes and Stable Ischemic Heart Disease: a BARI-2D Substudy
Background: : High-sensitivity cardiac troponin T (hsTnT) and B-type natriuretic peptides (NT-proBNP) are strongly associated with death and major cardiovascular (CV) events, and are often elevated in patients with T2D and stable ischemic heart disease (SIHD). Whether these biomarkers change over time or are altered by revascularization or glucose control strategies has not been well studied.
Methods and Results: We measured hsTnT and NT-proBNP at baseline and after 1 year of follow up in 1984 patients enrolled in BARI-2D (NCT00006305), a 2x2 factorial randomized controlled trial in patients with T2D and SIHD of insulin sensitization (IS) vs. insulin provision (IP) and initial revascularization vs. medical therapy. At baseline, all 1984 patients had a detectable hsTnT (≥3 ng/L) or NT-proBNP (≥5 ng/L). There was a modest but significant increase in both markers with a median (IQR) increase of 3.4% (-4.8, 11.1) in log(hsTnT) and 3.5% (-7.7, 16.3) in log(NT-proBNP) (each P<0.001). We observed no significant differences in the percent change in log(hsTnT) when the IS group was compared to the IP group (P=0.39), or when revascularization was compared to medical therapy (P=0.40; Figure). The median (IQR) percent change in log(NT-proBNP) concentrations in the IS group [6.1% (-5.7, 19.5)] was significantly greater than in the IP group [1.6% (-10.3, 12.7); P<0.001; Figure], but no significant differences were noted when initial revascularization was compared to medical therapy (P=0.08; Figure).
Conclusions: A high proportion of patients with T2D and SIHD have measurable circulating cardiac troponin and NT-proBNP levels. The change in cardiac troponin concentrations does not differ by insulin sensitization vs. provision strategies for T2D, or by initial revascularization vs. medical therapy for SIHD. By contrast, we observed NT-proBNP concentrations increased at 1-year among those randomized to an insulin sensitization compared to those an insulin provision strategy.
Author Disclosures: B.M. Everett: Research Grant; Significant; Roche Diagnostics, Novartis Pharmaceuticals. Consultant/Advisory Board; Modest; Socar Research. M. Brooks: Research Grant; Significant; Genway Biotech, Inc.. H. Vlachos: None. B. Chaitman: None. R. Frye: None. D. Bhatt: Research Grant; Significant; Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Medtronic, Roche, Sanofi Aventis, The Medicines Company.
- © 2014 by American Heart Association, Inc.