@article{20436,
  author = {Zoungas S. and Sattar N. and Woodward Mark and Welsh P. and Poulter N. and Williams B. and Mancia G. and Jun M. and Hillis G. and Q. Mbiostat Li and Chalmers J. and Chow Clara and Perkovic Vlado and Neal Bruce},
  title = {The relative and combined ability of high sensitivity cardiac troponin T and N-terminal pro-BNP to predict cardiovascular events and death in patients with type 2 diabetes mellitus},
  abstract = {<p>
ObjectiveCurrent methods of risk-stratification in patients with type 2 diabetes are suboptimal. The current study assesses the ability of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high sensitivity cardiac troponin T (hs-cTnT) to improve the prediction of cardiovascular events and death in patients with type 2 diabetes.Research Design and MethodsA nested case-cohort study was performed in 3,862 patients who participated in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation trial.ResultsSeven hundred and nine (18%) patients experienced a major cardiovascular event (composite of cardiovascular death, non-fatal myocardial infarction or non-fatal stroke) and 706 (18%) died during a median of 5 years follow-up. In Cox regression models, adjusting for all established risk predictors, the hazard ratio [HR] for cardiovascular events for NT-proBNP was 1.95 per 1 standard deviation [SD] increase (95% confidence interval [CI] 1.72-2.20) and the HR for hs-cTnT was 1.50 per 1 SD increase (95% CI 1.36-1.65). The HRs for death were 1.97 (95% CI 1.73-2.24) and 1.52 (95% CI 1.37-1.67), respectively. The addition of either marker improved 5-year risk classification for cardiovascular events (net reclassification index in continuous model, 39% for NT-proBNP and 46% for hs-cTnT). Likewise, both markers greatly improved the accuracy with which the 5-year risk of death was predicted. The combination of both markers provided optimal risk discrimination.ConclusionNT-proBNP and hs-cTnT appear to greatly improve the accuracy with which the risk of cardiovascular events or death can be estimated in patients with type 2 diabetes.
</p>
},
  year = {2013},
  journal = {Diabetes Care},
  edition = {2013/10/04 [Epub ahead of print]},
  isbn = {1935-5548 (Electronic)<br/>0149-5992 (Linking)},
  note = {Hillis, Graham S<br/>Welsh, Paul<br/>Chalmers, John<br/>Perkovic, Vlado<br/>Chow, Clara K<br/>Li Mbiostat, Qiang<br/>Jun, Min<br/>Neal, Bruce<br/>Zoungas, Sophia<br/>Poulter, Neil<br/>Mancia, Giuseppe<br/>Williams, Bryan<br/>Sattar, Naveed<br/>Woodward, Mark<br/>Diabetes Care. 2013 Oct 2.},
  language = {Eng},
}