High-sensitivity troponin T (hsTnT), a marker of CVD, and N-Terminal pro B-Type Natriuretic Peptide (NT-proBNP), a marker of heart failure, have not been widely studied in type 1 diabetes. We thus assessed the ability of these markers to independently predict CVD and MACE in a cohort with childhood-onset T1D (n=583, mean age 29 and duration 21 years) during a median follow-up of 21 years. CVD was defined as CVD death, myocardial infarction, revascularization, angina, or ischemia, and MACE as CVD death, myocardial infarction, or stroke. hsTnT and NT-proBNP were assessed with electrochemiluminescence immunoassays. Median hsTnT was 5.0 ng/L (IQR: 2.0, 10.0) and median NT-proBNP was 22.0 pg/mL (7.0, 61.0). In Cox proportional hazards models allowing for diabetes duration, gender, BMI, smoking status, HbA1c, hypertension status, HDL and non-HDL cholesterol, white blood cell count, estimated glomerular filtration rate and albumin excretion rate, both log hsTnT (HR=1.30, 95% CI: 1.06-1.59) and log NT-proBNP (HR=1.29, 95% CI: 1.13-1.48) independently predicted CVD. However, the prediction of CVD between models with and without these two markers improved only marginally (Uno’s concordance statistic p=0.06). Furthermore, log hsTnT was a slightly weaker predictor of MACE (HR=1.22, 95% CI: 0.97-1.55) compared with log NT-proBNP (HR=1.28, 95% CI: 1.11-1.47). The addition of these two markers to models already including traditional risk factors did not enhance MACE prediction (p=0.39).

In conclusion, although hsTnT and NT-proBNP independently predicted both CVD and MACE, they marginally increased the area under the curve only for CAD in this type 1 diabetes cohort.


T. Costacou: None. A.K. Saenger: None. T.J. Orchard: Consultant; Self; Boehringer Ingelheim International GmbH.


National Institutes of Health (DK34818); Rossi Memorial Fund

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.