Introduction: ADA guidelines recommend costly cardioprotective medications as second-line therapy for patients with diabetes and prevalent cardiovascular disease (CVD). High sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI) may identify those at high risk in the absence of CVD and inform prioritization for treatment with newer classes of medications.

Methods: We conducted a prospective cohort analysis of middle-age adults (mean age 63, 52% female, 30% black) in the Atherosclerosis Risk in Communities (ARIC) Study with diabetes (1996-1998, n=1,415). Participants were followed >20 years for heart failure (HF), coronary heart disease, and death. We used Cox models to evaluate the risk associated with independent and joint elevations (>90th percentiles) in hs-cTnT and hs-cTnI.

Results: Elevations in hs-cTnT (26%) or I (19%) were common, with 10% of those without CVD having elevations in both. Elevated hs-cTnT and hs-cTnI were independently associated with all three outcomes (and jointly improved C-statistics). For HF and death, those with elevations in both troponins in the absence of CVD showed similar risk as those with prevalent CVD (Table).

Conclusions: Hs-cTnT and I are independently prognostic of cardiovascular risk and mortality among adults with diabetes. These biomarkers may help identify patients for novel cardioprotective anti-hyperglycemics, even in the absence of pre-existing CVD.
Disclosure

O. Tang: None. K. Matsushita: Consultant; Self; Akebia, Kyowa Hakko Kirin Co., Ltd. Research Support; Self; Fukuda Denshi, Kyowa Hakko Kirin Co., Ltd. J. Coresh: None. B. Mcevoy: None. A. Sharrett: None. C.M. Ballantyne: Consultant; Self; Abbott, Akcea Therapeutics, Amarin Corporation, Amgen Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Esperion, Gilead Sciences, Inc., Matinas BioPharma, Merck & Co., Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Regeneron Pharmaceuticals, Roche Diagnostic USA, Sanofi. Research Support; Self; Abbott, Akcea Therapeutics, Amarin Corporation, Amgen Inc., Esperion, Novartis Pharmaceuticals Corporation, Regeneron Pharmaceuticals, Roche Diagnostic USA, Sanofi. Other Relationship; Self; Roche Diagnostic USA. R.C. Hoogeveen: Consultant; Self; Denka Seiken. Research Support; Self; Abbott, American Heart Association, National Heart, Lung, and Blood Institute, SomaLogic, Inc. E. Selvin: None.

Funding

National Institutes of Health

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