Cardiac stress and inflammatory markers as predictors of heart failure in patients with type 2 diabetes: the ADVANCE trial
Objective: This study examined the individual and combined impact of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hs-CRP) on the prediction of heart failure incidence or progressio...
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Journal article |
| Published: |
American Diabetes Association
2017
|
| _version_ | 1797102960217423872 |
|---|---|
| author | Ohkuma, T Jun, M Woodward, M Zoungas, S Cooper, M Grobbee, D Hamet, P Mancia, G Williams, B Welsh, P Sattar, N Shaw, J Rahimi, K Chalmers, J ADVANCE Collaborative Group |
| author_facet | Ohkuma, T Jun, M Woodward, M Zoungas, S Cooper, M Grobbee, D Hamet, P Mancia, G Williams, B Welsh, P Sattar, N Shaw, J Rahimi, K Chalmers, J ADVANCE Collaborative Group |
| author_sort | Ohkuma, T |
| collection | OXFORD |
| description | Objective: This study examined the individual and combined impact of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hs-CRP) on the prediction of heart failure incidence or progression in patients with type 2 diabetes. <br/><br/>Research Design and Methods: A nested case-cohort study was conducted in 3,098 participants with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. <br/><br/>Results: A higher value of each biomarker was significantly associated with a higher risk of heart failure incidence or progression, after adjustment for major risk factors. The hazard ratios per 1-SD increase were 3.06 (95% CI 2.37-3.96) for NT-proBNP, 1.50 (1.27-1.77) for hs-cTnT, 1.48 (1.27-1.72) for IL-6, and 1.32 (1.12-1.55) for hs-CRP. Addition of NT-proBNP to the model including conventional risk factors meaningfully improved 5-year risk predictive performance (c-statistic 0.8162 to 0.8800; continuous net reclassification improvement [NRI] 73.1%; categorical NRI [<5%, 5-10%, >10% 5-year risk] 24.2%). In contrast, addition of hs-cTnT, IL-6 or hs-CRP did not improve the prediction metrics consistently either in combination or when added to NT-proBNP. <br/><br/>Conclusions: Only NT-proBNP, strongly and consistently improved prediction of heart failure in patients with type 2 diabetes beyond a wide range of clinical risk factors and biomarkers. |
| first_indexed | 2024-03-07T06:13:16Z |
| format | Journal article |
| id | oxford-uuid:f03fab13-7c3c-421a-8efb-5dfbe57b428e |
| institution | University of Oxford |
| last_indexed | 2024-03-07T06:13:16Z |
| publishDate | 2017 |
| publisher | American Diabetes Association |
| record_format | dspace |
| spelling | oxford-uuid:f03fab13-7c3c-421a-8efb-5dfbe57b428e2022-03-27T11:46:26ZCardiac stress and inflammatory markers as predictors of heart failure in patients with type 2 diabetes: the ADVANCE trialJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:f03fab13-7c3c-421a-8efb-5dfbe57b428eSymplectic Elements at OxfordAmerican Diabetes Association2017Ohkuma, TJun, MWoodward, MZoungas, SCooper, MGrobbee, DHamet, PMancia, GWilliams, BWelsh, PSattar, NShaw, JRahimi, KChalmers, JADVANCE Collaborative GroupObjective: This study examined the individual and combined impact of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hs-CRP) on the prediction of heart failure incidence or progression in patients with type 2 diabetes. <br/><br/>Research Design and Methods: A nested case-cohort study was conducted in 3,098 participants with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. <br/><br/>Results: A higher value of each biomarker was significantly associated with a higher risk of heart failure incidence or progression, after adjustment for major risk factors. The hazard ratios per 1-SD increase were 3.06 (95% CI 2.37-3.96) for NT-proBNP, 1.50 (1.27-1.77) for hs-cTnT, 1.48 (1.27-1.72) for IL-6, and 1.32 (1.12-1.55) for hs-CRP. Addition of NT-proBNP to the model including conventional risk factors meaningfully improved 5-year risk predictive performance (c-statistic 0.8162 to 0.8800; continuous net reclassification improvement [NRI] 73.1%; categorical NRI [<5%, 5-10%, >10% 5-year risk] 24.2%). In contrast, addition of hs-cTnT, IL-6 or hs-CRP did not improve the prediction metrics consistently either in combination or when added to NT-proBNP. <br/><br/>Conclusions: Only NT-proBNP, strongly and consistently improved prediction of heart failure in patients with type 2 diabetes beyond a wide range of clinical risk factors and biomarkers. |
| spellingShingle | Ohkuma, T Jun, M Woodward, M Zoungas, S Cooper, M Grobbee, D Hamet, P Mancia, G Williams, B Welsh, P Sattar, N Shaw, J Rahimi, K Chalmers, J ADVANCE Collaborative Group Cardiac stress and inflammatory markers as predictors of heart failure in patients with type 2 diabetes: the ADVANCE trial |
| title | Cardiac stress and inflammatory markers as predictors of heart failure in patients with type 2 diabetes: the ADVANCE trial |
| title_full | Cardiac stress and inflammatory markers as predictors of heart failure in patients with type 2 diabetes: the ADVANCE trial |
| title_fullStr | Cardiac stress and inflammatory markers as predictors of heart failure in patients with type 2 diabetes: the ADVANCE trial |
| title_full_unstemmed | Cardiac stress and inflammatory markers as predictors of heart failure in patients with type 2 diabetes: the ADVANCE trial |
| title_short | Cardiac stress and inflammatory markers as predictors of heart failure in patients with type 2 diabetes: the ADVANCE trial |
| title_sort | cardiac stress and inflammatory markers as predictors of heart failure in patients with type 2 diabetes the advance trial |
| work_keys_str_mv | AT ohkumat cardiacstressandinflammatorymarkersaspredictorsofheartfailureinpatientswithtype2diabetestheadvancetrial AT junm cardiacstressandinflammatorymarkersaspredictorsofheartfailureinpatientswithtype2diabetestheadvancetrial AT woodwardm cardiacstressandinflammatorymarkersaspredictorsofheartfailureinpatientswithtype2diabetestheadvancetrial AT zoungass cardiacstressandinflammatorymarkersaspredictorsofheartfailureinpatientswithtype2diabetestheadvancetrial AT cooperm cardiacstressandinflammatorymarkersaspredictorsofheartfailureinpatientswithtype2diabetestheadvancetrial AT grobbeed cardiacstressandinflammatorymarkersaspredictorsofheartfailureinpatientswithtype2diabetestheadvancetrial AT hametp cardiacstressandinflammatorymarkersaspredictorsofheartfailureinpatientswithtype2diabetestheadvancetrial AT manciag cardiacstressandinflammatorymarkersaspredictorsofheartfailureinpatientswithtype2diabetestheadvancetrial AT williamsb cardiacstressandinflammatorymarkersaspredictorsofheartfailureinpatientswithtype2diabetestheadvancetrial AT welshp cardiacstressandinflammatorymarkersaspredictorsofheartfailureinpatientswithtype2diabetestheadvancetrial AT sattarn cardiacstressandinflammatorymarkersaspredictorsofheartfailureinpatientswithtype2diabetestheadvancetrial AT shawj cardiacstressandinflammatorymarkersaspredictorsofheartfailureinpatientswithtype2diabetestheadvancetrial AT rahimik cardiacstressandinflammatorymarkersaspredictorsofheartfailureinpatientswithtype2diabetestheadvancetrial AT chalmersj cardiacstressandinflammatorymarkersaspredictorsofheartfailureinpatientswithtype2diabetestheadvancetrial AT advancecollaborativegroup cardiacstressandinflammatorymarkersaspredictorsofheartfailureinpatientswithtype2diabetestheadvancetrial |