Targeted multiple biomarker approach in predicting cardiovascular events in patients with diabetes
ObjectiveWe hypothesised that biomarkers representing different pathophysiological pathways of atherosclerosis namely growth differentiation factor 15 (GDF-15), N-terminal pro B-type natriuretic peptide (NT-proBNP) and high-sensitive troponin T (hs-TnT) could enhance cardiovascular risk prediction i...
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| Veröffentlicht in: | Heart (British Cardiac Society) 2016-12, Vol.102 (24), p.1963-1968 |
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| container_end_page | 1968 |
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| container_issue | 24 |
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| container_title | Heart (British Cardiac Society) |
| container_volume | 102 |
| creator | Resl, M Clodi, M Vila, G Luger, A Neuhold, S Wurm, R Adlbrecht, C Strunk, G Fritzer-Szekeres, M Prager, R Pacher, R Hülsmann, M |
| description | ObjectiveWe hypothesised that biomarkers representing different pathophysiological pathways of atherosclerosis namely growth differentiation factor 15 (GDF-15), N-terminal pro B-type natriuretic peptide (NT-proBNP) and high-sensitive troponin T (hs-TnT) could enhance cardiovascular risk prediction in patients with type 2 diabetes mellitus.MethodsThis is a prospective study in 746 patients with type 2 diabetes mellitus, who were followed up for 60 months. The primary endpoint was defined as unplanned hospitalisation for cardiovascular disease or death. The prognostic performance of the biomarkers of interest (GDF-15 in comparison with NT-proBNP and hs-TnT) was evaluated in univariate as well as in stepwise Cox regression models. HRs are presented per standard unit increase.ResultsThe primary endpoint was registered in 171 patients (22.9%). In univariate Cox regression models, GDF-15 as well as hs-TnT provided significant prognostic information. Even after adjusting for established cardiovascular risk factors, GDF-15, hs-TnT and NT-proBNP remained strong independent predictors of the endpoint (logGDF-15: HR 1.37, p |
| doi_str_mv | 10.1136/heartjnl-2015-308949 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1850782459</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1850782459</sourcerecordid><originalsourceid>FETCH-LOGICAL-b380t-99bd8dad577be9a8888c49938a0c6c3ca357c2aa79c26c63c635de710271726e3</originalsourceid><addsrcrecordid>eNqNkctqHDEQRUWIyTi2_yCEXmbTth6t1zIMiRMweGODd021VPZo0q9Iagf_vTUeT9YjBLqIU7eKuoR8YfSSMaGuNggxb8e-5pTJWlBjG_uBnLJGmd3Xw8eihZS1okKvyOeUtpTSxhr1iay4bqTiip2S7g7iE2b01bD0Ocw9Vl2YBoh_MFYwz3ECt6nCWM0RfXA5jE-Vg-jD9AzJLT3ECp9xzOmNgRze9L-QN5UP0BXndE5OHqFPePH-npH7nz_u1r_qm9vr3-vvN3UnDM21tZ03HrzUukMLphzXWCsMUKeccCCkdhxAW8eVU6Jc6VEzyjXTXKE4I9_2vmXovwum3A4hOex7GHFaUsuMpNrwRtojUK4015zygjZ71MUppYiP7RxD2c9Ly2i7C6I9BNHugmj3QZSyr-8dlm5A_7_osPkCXO2BbtgeZ_kK_FmW7A</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1826727202</pqid></control><display><type>article</type><title>Targeted multiple biomarker approach in predicting cardiovascular events in patients with diabetes</title><source>MEDLINE</source><source>BMJ Journals - NESLi2</source><source>PubMed Central</source><creator>Resl, M ; Clodi, M ; Vila, G ; Luger, A ; Neuhold, S ; Wurm, R ; Adlbrecht, C ; Strunk, G ; Fritzer-Szekeres, M ; Prager, R ; Pacher, R ; Hülsmann, M</creator><creatorcontrib>Resl, M ; Clodi, M ; Vila, G ; Luger, A ; Neuhold, S ; Wurm, R ; Adlbrecht, C ; Strunk, G ; Fritzer-Szekeres, M ; Prager, R ; Pacher, R ; Hülsmann, M</creatorcontrib><description>ObjectiveWe hypothesised that biomarkers representing different pathophysiological pathways of atherosclerosis namely growth differentiation factor 15 (GDF-15), N-terminal pro B-type natriuretic peptide (NT-proBNP) and high-sensitive troponin T (hs-TnT) could enhance cardiovascular risk prediction in patients with type 2 diabetes mellitus.MethodsThis is a prospective study in 746 patients with type 2 diabetes mellitus, who were followed up for 60 months. The primary endpoint was defined as unplanned hospitalisation for cardiovascular disease or death. The prognostic performance of the biomarkers of interest (GDF-15 in comparison with NT-proBNP and hs-TnT) was evaluated in univariate as well as in stepwise Cox regression models. HRs are presented per standard unit increase.ResultsThe primary endpoint was registered in 171 patients (22.9%). In univariate Cox regression models, GDF-15 as well as hs-TnT provided significant prognostic information. Even after adjusting for established cardiovascular risk factors, GDF-15, hs-TnT and NT-proBNP remained strong independent predictors of the endpoint (logGDF-15: HR 1.37, p<0.01, CI 1.12 to 1.68; loghs-TnT: HR 1.43, p<0.01, CI 1.13 to 1.1.82; logNT-proBNP: HR 1.45, p<0.01, CI 1.26 to 1.66). The number of elevated markers showed a strong complementarity to predict future long-term risk. Adding hs-TnT and GDF-15 to a zero model already including NT-proBNP led to a net reclassification improvement (NRI) of 33.6% (CI 16.0% to 50.8%, NRI for patients with event: 11.1% CI −4.7% to 26.6%, for patients without event: 22.5% CI 13.6% to 30.5%).ConclusionsGDF-15 and hs-TnT are strong independent cardiovascular biomarkers augmenting the predictive value of NT-proBNP in patients with diabetes.</description><identifier>ISSN: 1355-6037</identifier><identifier>EISSN: 1468-201X</identifier><identifier>DOI: 10.1136/heartjnl-2015-308949</identifier><identifier>PMID: 27456261</identifier><language>eng</language><publisher>England</publisher><subject>Adult ; Aged ; Austria ; Biomarkers - blood ; Cardiovascular Diseases - blood ; Cardiovascular Diseases - diagnosis ; Cardiovascular Diseases - mortality ; Cardiovascular Diseases - therapy ; Diabetes Mellitus, Type 2 - blood ; Diabetes Mellitus, Type 2 - diagnosis ; Diabetes Mellitus, Type 2 - mortality ; Diabetes Mellitus, Type 2 - therapy ; Disease Progression ; Female ; Growth Differentiation Factor 15 - blood ; Hospitalization ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Natriuretic Peptide, Brain - blood ; Peptide Fragments - blood ; Predictive Value of Tests ; Prevalence ; Prognosis ; Proportional Hazards Models ; Prospective Studies ; Registries ; Risk Assessment ; Risk Factors ; Time Factors ; Troponin T - blood ; Up-Regulation</subject><ispartof>Heart (British Cardiac Society), 2016-12, Vol.102 (24), p.1963-1968</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b380t-99bd8dad577be9a8888c49938a0c6c3ca357c2aa79c26c63c635de710271726e3</citedby><cites>FETCH-LOGICAL-b380t-99bd8dad577be9a8888c49938a0c6c3ca357c2aa79c26c63c635de710271726e3</cites><orcidid>0000-0003-3027-7775</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://heart.bmj.com/content/102/24/1963.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttps://heart.bmj.com/content/102/24/1963.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,776,780,3182,23551,27903,27904,77347,77378</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27456261$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Resl, M</creatorcontrib><creatorcontrib>Clodi, M</creatorcontrib><creatorcontrib>Vila, G</creatorcontrib><creatorcontrib>Luger, A</creatorcontrib><creatorcontrib>Neuhold, S</creatorcontrib><creatorcontrib>Wurm, R</creatorcontrib><creatorcontrib>Adlbrecht, C</creatorcontrib><creatorcontrib>Strunk, G</creatorcontrib><creatorcontrib>Fritzer-Szekeres, M</creatorcontrib><creatorcontrib>Prager, R</creatorcontrib><creatorcontrib>Pacher, R</creatorcontrib><creatorcontrib>Hülsmann, M</creatorcontrib><title>Targeted multiple biomarker approach in predicting cardiovascular events in patients with diabetes</title><title>Heart (British Cardiac Society)</title><addtitle>Heart</addtitle><description>ObjectiveWe hypothesised that biomarkers representing different pathophysiological pathways of atherosclerosis namely growth differentiation factor 15 (GDF-15), N-terminal pro B-type natriuretic peptide (NT-proBNP) and high-sensitive troponin T (hs-TnT) could enhance cardiovascular risk prediction in patients with type 2 diabetes mellitus.MethodsThis is a prospective study in 746 patients with type 2 diabetes mellitus, who were followed up for 60 months. The primary endpoint was defined as unplanned hospitalisation for cardiovascular disease or death. The prognostic performance of the biomarkers of interest (GDF-15 in comparison with NT-proBNP and hs-TnT) was evaluated in univariate as well as in stepwise Cox regression models. HRs are presented per standard unit increase.ResultsThe primary endpoint was registered in 171 patients (22.9%). In univariate Cox regression models, GDF-15 as well as hs-TnT provided significant prognostic information. Even after adjusting for established cardiovascular risk factors, GDF-15, hs-TnT and NT-proBNP remained strong independent predictors of the endpoint (logGDF-15: HR 1.37, p<0.01, CI 1.12 to 1.68; loghs-TnT: HR 1.43, p<0.01, CI 1.13 to 1.1.82; logNT-proBNP: HR 1.45, p<0.01, CI 1.26 to 1.66). The number of elevated markers showed a strong complementarity to predict future long-term risk. Adding hs-TnT and GDF-15 to a zero model already including NT-proBNP led to a net reclassification improvement (NRI) of 33.6% (CI 16.0% to 50.8%, NRI for patients with event: 11.1% CI −4.7% to 26.6%, for patients without event: 22.5% CI 13.6% to 30.5%).ConclusionsGDF-15 and hs-TnT are strong independent cardiovascular biomarkers augmenting the predictive value of NT-proBNP in patients with diabetes.</description><subject>Adult</subject><subject>Aged</subject><subject>Austria</subject><subject>Biomarkers - blood</subject><subject>Cardiovascular Diseases - blood</subject><subject>Cardiovascular Diseases - diagnosis</subject><subject>Cardiovascular Diseases - mortality</subject><subject>Cardiovascular Diseases - therapy</subject><subject>Diabetes Mellitus, Type 2 - blood</subject><subject>Diabetes Mellitus, Type 2 - diagnosis</subject><subject>Diabetes Mellitus, Type 2 - mortality</subject><subject>Diabetes Mellitus, Type 2 - therapy</subject><subject>Disease Progression</subject><subject>Female</subject><subject>Growth Differentiation Factor 15 - blood</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Natriuretic Peptide, Brain - blood</subject><subject>Peptide Fragments - blood</subject><subject>Predictive Value of Tests</subject><subject>Prevalence</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Registries</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Troponin T - blood</subject><subject>Up-Regulation</subject><issn>1355-6037</issn><issn>1468-201X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkctqHDEQRUWIyTi2_yCEXmbTth6t1zIMiRMweGODd021VPZo0q9Iagf_vTUeT9YjBLqIU7eKuoR8YfSSMaGuNggxb8e-5pTJWlBjG_uBnLJGmd3Xw8eihZS1okKvyOeUtpTSxhr1iay4bqTiip2S7g7iE2b01bD0Ocw9Vl2YBoh_MFYwz3ECt6nCWM0RfXA5jE-Vg-jD9AzJLT3ECp9xzOmNgRze9L-QN5UP0BXndE5OHqFPePH-npH7nz_u1r_qm9vr3-vvN3UnDM21tZ03HrzUukMLphzXWCsMUKeccCCkdhxAW8eVU6Jc6VEzyjXTXKE4I9_2vmXovwum3A4hOex7GHFaUsuMpNrwRtojUK4015zygjZ71MUppYiP7RxD2c9Ly2i7C6I9BNHugmj3QZSyr-8dlm5A_7_osPkCXO2BbtgeZ_kK_FmW7A</recordid><startdate>20161215</startdate><enddate>20161215</enddate><creator>Resl, M</creator><creator>Clodi, M</creator><creator>Vila, G</creator><creator>Luger, A</creator><creator>Neuhold, S</creator><creator>Wurm, R</creator><creator>Adlbrecht, C</creator><creator>Strunk, G</creator><creator>Fritzer-Szekeres, M</creator><creator>Prager, R</creator><creator>Pacher, R</creator><creator>Hülsmann, M</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>P64</scope><orcidid>https://orcid.org/0000-0003-3027-7775</orcidid></search><sort><creationdate>20161215</creationdate><title>Targeted multiple biomarker approach in predicting cardiovascular events in patients with diabetes</title><author>Resl, M ; Clodi, M ; Vila, G ; Luger, A ; Neuhold, S ; Wurm, R ; Adlbrecht, C ; Strunk, G ; Fritzer-Szekeres, M ; Prager, R ; Pacher, R ; Hülsmann, M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b380t-99bd8dad577be9a8888c49938a0c6c3ca357c2aa79c26c63c635de710271726e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Austria</topic><topic>Biomarkers - blood</topic><topic>Cardiovascular Diseases - blood</topic><topic>Cardiovascular Diseases - diagnosis</topic><topic>Cardiovascular Diseases - mortality</topic><topic>Cardiovascular Diseases - therapy</topic><topic>Diabetes Mellitus, Type 2 - blood</topic><topic>Diabetes Mellitus, Type 2 - diagnosis</topic><topic>Diabetes Mellitus, Type 2 - mortality</topic><topic>Diabetes Mellitus, Type 2 - therapy</topic><topic>Disease Progression</topic><topic>Female</topic><topic>Growth Differentiation Factor 15 - blood</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Natriuretic Peptide, Brain - blood</topic><topic>Peptide Fragments - blood</topic><topic>Predictive Value of Tests</topic><topic>Prevalence</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Registries</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Troponin T - blood</topic><topic>Up-Regulation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Resl, M</creatorcontrib><creatorcontrib>Clodi, M</creatorcontrib><creatorcontrib>Vila, G</creatorcontrib><creatorcontrib>Luger, A</creatorcontrib><creatorcontrib>Neuhold, S</creatorcontrib><creatorcontrib>Wurm, R</creatorcontrib><creatorcontrib>Adlbrecht, C</creatorcontrib><creatorcontrib>Strunk, G</creatorcontrib><creatorcontrib>Fritzer-Szekeres, M</creatorcontrib><creatorcontrib>Prager, R</creatorcontrib><creatorcontrib>Pacher, R</creatorcontrib><creatorcontrib>Hülsmann, M</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><jtitle>Heart (British Cardiac Society)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Resl, M</au><au>Clodi, M</au><au>Vila, G</au><au>Luger, A</au><au>Neuhold, S</au><au>Wurm, R</au><au>Adlbrecht, C</au><au>Strunk, G</au><au>Fritzer-Szekeres, M</au><au>Prager, R</au><au>Pacher, R</au><au>Hülsmann, M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Targeted multiple biomarker approach in predicting cardiovascular events in patients with diabetes</atitle><jtitle>Heart (British Cardiac Society)</jtitle><addtitle>Heart</addtitle><date>2016-12-15</date><risdate>2016</risdate><volume>102</volume><issue>24</issue><spage>1963</spage><epage>1968</epage><pages>1963-1968</pages><issn>1355-6037</issn><eissn>1468-201X</eissn><abstract>ObjectiveWe hypothesised that biomarkers representing different pathophysiological pathways of atherosclerosis namely growth differentiation factor 15 (GDF-15), N-terminal pro B-type natriuretic peptide (NT-proBNP) and high-sensitive troponin T (hs-TnT) could enhance cardiovascular risk prediction in patients with type 2 diabetes mellitus.MethodsThis is a prospective study in 746 patients with type 2 diabetes mellitus, who were followed up for 60 months. The primary endpoint was defined as unplanned hospitalisation for cardiovascular disease or death. The prognostic performance of the biomarkers of interest (GDF-15 in comparison with NT-proBNP and hs-TnT) was evaluated in univariate as well as in stepwise Cox regression models. HRs are presented per standard unit increase.ResultsThe primary endpoint was registered in 171 patients (22.9%). In univariate Cox regression models, GDF-15 as well as hs-TnT provided significant prognostic information. Even after adjusting for established cardiovascular risk factors, GDF-15, hs-TnT and NT-proBNP remained strong independent predictors of the endpoint (logGDF-15: HR 1.37, p<0.01, CI 1.12 to 1.68; loghs-TnT: HR 1.43, p<0.01, CI 1.13 to 1.1.82; logNT-proBNP: HR 1.45, p<0.01, CI 1.26 to 1.66). The number of elevated markers showed a strong complementarity to predict future long-term risk. Adding hs-TnT and GDF-15 to a zero model already including NT-proBNP led to a net reclassification improvement (NRI) of 33.6% (CI 16.0% to 50.8%, NRI for patients with event: 11.1% CI −4.7% to 26.6%, for patients without event: 22.5% CI 13.6% to 30.5%).ConclusionsGDF-15 and hs-TnT are strong independent cardiovascular biomarkers augmenting the predictive value of NT-proBNP in patients with diabetes.</abstract><cop>England</cop><pmid>27456261</pmid><doi>10.1136/heartjnl-2015-308949</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0003-3027-7775</orcidid></addata></record> |
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| subjects | Adult Aged Austria Biomarkers - blood Cardiovascular Diseases - blood Cardiovascular Diseases - diagnosis Cardiovascular Diseases - mortality Cardiovascular Diseases - therapy Diabetes Mellitus, Type 2 - blood Diabetes Mellitus, Type 2 - diagnosis Diabetes Mellitus, Type 2 - mortality Diabetes Mellitus, Type 2 - therapy Disease Progression Female Growth Differentiation Factor 15 - blood Hospitalization Humans Kaplan-Meier Estimate Male Middle Aged Natriuretic Peptide, Brain - blood Peptide Fragments - blood Predictive Value of Tests Prevalence Prognosis Proportional Hazards Models Prospective Studies Registries Risk Assessment Risk Factors Time Factors Troponin T - blood Up-Regulation |
| title | Targeted multiple biomarker approach in predicting cardiovascular events in patients with diabetes |
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