User: Guest  Login
Document type:
Article; Journal Article; Research Support, Non-U.S. Gov't
Author(s):
Haller, Paul M; Goßling, Alina; Magnussen, Christina; Brenner, Hermann; Schöttker, Ben; Iacoviello, Licia; Costanzo, Simona; Kee, Frank; Koenig, Wolfgang; Linneberg, Allan; Sujana, Chaterina; Thorand, Barbara; Salomaa, Veikko; Niiranen, Teemu J; Söderberg, Stefan; Völzke, Henry; Dörr, Marcus; Sans, Susana; Padró, Teresa; Felix, Stephan B; Nauck, Matthias; Petersmann, Astrid; Palmieri, Luigi; Donfrancesco, Chiara; De Ponti, Roberto; Veronesi, Giovanni; Ferrario, Marco M; Kuulasmaa, Kari; Zeller,...     »
Title:
Biomarker-based prediction of fatal and non-fatal cardiovascular outcomes in individuals with diabetes mellitus.
Abstract:
AIMS: The role of biomarkers in predicting cardiovascular outcomes in high-risk individuals is not well established. We aimed to investigate benefits of adding biomarkers to cardiovascular risk assessment in individuals with and without diabetes. METHODS AND RESULTS: We used individual-level data of 95 292 individuals of the European population harmonized in the Biomarker for Cardiovascular Risk Assessment across Europe consortium and investigated the prognostic ability of high-sensitivity cardiac troponin I (hs-cTnI), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hs-CRP). Cox-regression models were used to determine adjusted hazard ratios of diabetes and log-transformed biomarkers for fatal and non-fatal cardiovascular events. Models were compared using the likelihood ratio test. Stratification by specific biomarker cut-offs was performed for crude time-to-event analysis using Kaplan-Meier plots. Overall, 6090 (6.4%) individuals had diabetes at baseline, median follow-up was 9.9 years. Adjusting for classical risk factors and biomarkers, diabetes [HR 2.11 (95% CI 1.92, 2.32)], and all biomarkers (HR per interquartile range hs-cTnI 1.08 [95% CI 1.04, 1.12]; NT-proBNP 1.44 [95% CI 1.37, 1.53]; hs-CRP 1.27 [95% CI 1.21, 1.33]) were independently associated with cardiovascular events. Specific cut-offs for each biomarker identified a high-risk group of individuals with diabetes losing a median of 15.5 years of life compared to diabetics without elevated biomarkers. Addition of biomarkers to the Cox-model significantly improved the prediction of outcomes (likelihood ratio test for nested models P < 0.001), accompanied by an increase in the c-index (increase to 0.81). CONCLUSION: Biomarkers improve cardiovascular risk prediction in individuals with and without diabetes and facilitate the identification of individuals with diabetes at highest risk for cardiovascular events.
Journal title abbreviation:
Eur J Prev Cardiol
Year:
2023
Journal volume:
30
Journal issue:
12
Pages contribution:
1218-1226
Fulltext / DOI:
doi:10.1093/eurjpc/zwad122
Pubmed ID:
http://view.ncbi.nlm.nih.gov/pubmed/37079290
Print-ISSN:
2047-4873
TUM Institution:
273; Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (DHM) (Prof. Schunkert)
 BibTeX