Oral Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

Cardiac stress and inflammatory markers as predictors of heart failure in patients with type 2 diabetes: the ADVANCE trial (#5)

Toshiaki Ohkuma 1 , Min Jun 1 , Sophia Zoungas 2 , Paul Welsh 3 , Naveed Sattar 3 , Mark E. Cooper 4 , Jonathan E. Shaw 5 , John Chalmers 1 , Mark Woodward 1 6 7
  1. The George Institute for Global Health, University of Sydney, Camperdown, NSW, Australia
  2. School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  3. Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
  4. Diabetic Complications Division, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
  5. Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
  6. The George Institute for Global Health, University of Oxford, Oxford, UK
  7. Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA

Background: Heart failure has been noted to be the second most common first presentation of cardiovascular disease in patients with type 2 diabetes, and more common than myocardial infarction. However, few studies have investigated the prognostic ability of circulating biomarkers for heart failure in patients with type 2 diabetes.

Objective: This study examined the individual and combined impact of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hs-CRP) on the prediction of heart failure incidence or progression in patients with type 2 diabetes.

Research Design and Methods: A nested case-cohort study was conducted in 3,098 participants with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial.

Results: A higher value of each biomarker was significantly associated with a higher risk of heart failure incidence or progression, after adjustment for major risk factors. The hazard ratios per 1-SD increase were 3.06 (95% CI 2.37-3.96) for NT-proBNP, 1.50 (1.27-1.77) for hs-cTnT, 1.48 (1.27-1.72) for IL-6, and 1.32 (1.12-1.55) for hs-CRP. Addition of NT-proBNP to the model including conventional risk factors meaningfully improved 5-year risk predictive performance (c-statistic 0.8162 to 0.8800; continuous net reclassification improvement [NRI] 73.1%; categorical NRI [<5%, 5-10%, >10% 5-year risk] 24.2%). In contrast, addition of hs-cTnT, IL-6 or hs-CRP did not improve the prediction metrics consistently either in combination or when added to NT-proBNP.

Conclusions: Only NT-proBNP, strongly and consistently improved prediction of heart failure in patients with type 2 diabetes beyond a wide range of clinical risk factors and biomarkers.