88-OR: hsTroponin and NT-proBNP in Type 1 Diabetes (T1D): Association with Incident Cardiovascular Disease (CVD) and Major Atherosclerotic Cardiovascular Events (MACE)

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.