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Biomarker-based prediction of fatal and non-fatal cardiovascular outcomes in individuals with diabetes mellitus
Department for Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Martinistrasse 52, Hamburg, Germany.
Department for Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, Germany.
Department for Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Martinistrasse 52, Hamburg, Germany.
German Cancer Research Center, Division of Clinical Epidemiology and Aging Research, Im Neuenheimer Feld 280, Heidelberg, Germany.
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2023 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 30, no 12, p. 1218-1226Article in journal (Refereed) Published
Abstract [en]

AIMS: The role of biomarkers in predicting cardiovascular outcomes in high-risk individuals is not well established. We aimed to investigate benefits of adding biomarkers to cardiovascular risk assessment in individuals with and without diabetes. 'METHODS AND RESULTS: We used individual-level data of 95 292 individuals of the European population harmonized in the Biomarker for Cardiovascular Risk Assessment across Europe consortium and investigated the prognostic ability of high-sensitivity cardiac troponin I (hs-cTnI), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hs-CRP). Cox-regression models were used to determine adjusted hazard ratios of diabetes and log-transformed biomarkers for fatal and non-fatal cardiovascular events. Models were compared using the likelihood ratio test. Stratification by specific biomarker cut-offs was performed for crude time-to-event analysis using Kaplan-Meier plots. Overall, 6090 (6.4%) individuals had diabetes at baseline, median follow-up was 9.9 years. Adjusting for classical risk factors and biomarkers, diabetes [HR 2.11 (95% CI 1.92, 2.32)], and all biomarkers (HR per interquartile range hs-cTnI 1.08 [95% CI 1.04, 1.12]; NT-proBNP 1.44 [95% CI 1.37, 1.53]; hs-CRP 1.27 [95% CI 1.21, 1.33]) were independently associated with cardiovascular events. Specific cut-offs for each biomarker identified a high-risk group of individuals with diabetes losing a median of 15.5 years of life compared to diabetics without elevated biomarkers. Addition of biomarkers to the Cox-model significantly improved the prediction of outcomes (likelihood ratio test for nested models P < 0.001), accompanied by an increase in the c-index (increase to 0.81).

CONCLUSION: Biomarkers improve cardiovascular risk prediction in individuals with and without diabetes and facilitate the identification of individuals with diabetes at highest risk for cardiovascular events.

Place, publisher, year, edition, pages
2023. Vol. 30, no 12, p. 1218-1226
Keywords [en]
Biomarkers, Cardiovascular events, Diabetes, hs-CRP, hs-cTnI, NT-proBNP
National Category
Cardiac and Cardiovascular Systems Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:umu:diva-214279DOI: 10.1093/eurjpc/zwad122ISI: 000981976600001PubMedID: 37079290Scopus ID: 2-s2.0-85169848670OAI: oai:DiVA.org:umu-214279DiVA, id: diva2:1795912
Funder
EU, FP7, Seventh Framework Programme, HEALTH-F3-2010-242244EU, FP7, Seventh Framework Programme, HEALTH-F2-2011-278913EU, Horizon 2020, 825903EU, Horizon 2020, 847770Available from: 2023-09-11 Created: 2023-09-11 Last updated: 2023-09-11Bibliographically approved

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Söderberg, Stefan

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