Diabetes, Pre-Diabetes and Incidence of Subclinical Myocardial Damage
Background—Persons with pre-diabetes and diabetes are at high risk for cardiovascular events. However, the relationships of pre-diabetes and diabetes to development of subclinical myocardial damage are unclear.
Methods and Results—We measured cardiac troponin T with a highly sensitive assay (hs-cTnT) at two time points, 6 years apart, among 9,331 participants of the community-based Atherosclerosis Risk in Communities (ARIC) Study with no diabetes, pre-diabetes, or diabetes but without cardiovascular disease including silent MI by ECG. First, we examined incidence of elevated hs-cTnT (≥14 ng/L) at 6 years of follow-up. Second, we examined clinical outcomes during the subsequent ~14 years of follow-up among persons with and without incident elevated hs-cTnT. Cumulative probabilities of elevated hs-cTnT at 6 years among persons with no diabetes, pre-diabetes, and diabetes were 3.7%, 6.4%, and 10.8%, respectively. Compared to normoglycemic persons, the adjusted relative risks for incident elevated hs-cTnT were 1.38 (95%CI 1.07-1.77) for pre-diabetes and 2.46 (95%CI 1.77-3.42) for diabetes. Persons with diabetes and incident elevations in hs-cTnT were at a substantially higher risk of heart failure (HR 6.37, 95%CI 4.27-9.51), death (HR 4.36, 95%CI 3.14-6.07) and coronary heart disease (HR 3.84, 95%CI 2.52-5.84) compared to persons without diabetes and no incident elevation in hs-cTnT.
Conclusions—Pre-diabetes and diabetes were independently associated with development of subclinical myocardial damage, as assessed by hs-cTnT, and those persons with evidence of subclinical damage were at highest risk for clinical events. These results support a possible deleterious effect of hyperglycemia on the myocardium, possibly reflecting a microvascular etiology.
- Received April 25, 2014.
- Revision received August 5, 2014.
- Accepted August 13, 2014.