Background: High-sensitivity cardiac troponin T (hs-cTnT) and natriuretic peptide (NT-proBNP) are strongly associated with coronary heart disease, heart failure, and death in population-based studies. Little is known about the associations of these cardiac biomarkers with incident PAD in adults with type 2 diabetes.

Methods: We used Cox models to assess the associations of elevated baseline hs-cTnT (≥ 14 ng/L) and NT-proBNP (≥ 200 pg/mL) in participants in the ADVANCE trial with measured biomarkers and without PAD at baseline. We also modeled hs-cTnT and NTproBNP using restricted cubic splines.

Results: Incident PAD occurred in 417 of 6,428 ADVANCE participants during a median follow-up of 5 years. After multivariable adjustment, increasing baseline hs-cTnT and NT-proBNP were both associated with PAD (Figure). Modeled categorically, PAD risk was higher in participants with elevated hs-cTnT (HR 1.35, 95% CI 1.07-1.70) or NT-proBNP (HR 1.44, 95% CI 1.15-1.81). Participants with elevations of both biomarkers had the highest risk (HR 1.85, 95% CI 1.38-2.49).

Conclusion: Hs-cTnT and NT-proBNP were associated with incident PAD in adults with diabetes even after adjusting for cardiovascular risk factors. Cardiac biomarkers may be useful to identify persons with type 2 diabetes at risk for future PAD.


C.W. Hicks: None. D. Wang: None. K. Matsushita: Consultant; Self; Akebia, Kyowa Hakko Kirin Co., Ltd. Research Support; Self; Fukuda Denshi, Kyowa Hakko Kirin Co., Ltd. J. Chalmers: Research Support; Self; Idorsia. M. Woodward: Consultant; Self; Amgen Inc., Kirin. E. Selvin: None.

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