Abstract | BACKGROUND: METHODS AND RESULTS: We measured cardiac troponin T with a highly sensitive assay (hs-cTnT) at 2 time points, 6 years apart, among 9051 participants of the community-based Atherosclerosis Risk in Communities Study with no diabetes mellitus, or prediabetes, and without cardiovascular disease including silent myocardial infarction by ECG. First, we examined the incidence of elevated hs-cTnT (≥14 ng/L) at 6 years of follow-up. Second, we examined clinical outcomes during the subsequent ≈14 years of follow-up among persons with and without incident elevations in hs-cTnT. Cumulative probabilities of elevated hs-cTnT at 6 years among persons with no diabetes mellitus, prediabetes, and diabetes mellitus were 3.7%, 6.4%, and 10.8%, respectively. Compared with normoglycemic persons, the adjusted relative risks for incident elevated hs-cTnT were 1.40 (95% CI, 1.08-1.80) for prediabetes and 2.47 (95% CI, 1.78-3.43) for diabetes mellitus. Persons with diabetes mellitus and incident elevations in hs-cTnT were at a substantially higher risk of heart failure (hazard ratio, 6.37 [95% CI, 4.27-9.51]), death (hazard ratio, 4.36 [95% CI, 3.14-6.07]), and coronary heart disease (hazard ratio, 3.84 [95% CI, 2.52-5.84]) compared with persons without diabetes mellitus and no incident elevation in hs-cTnT. CONCLUSIONS:
Prediabetes and diabetes mellitus were independently associated with the development of subclinical myocardial damage, as assessed by hs-cTnT, and those persons with evidence of subclinical damage were at highest risk for clinical events. These results support a possible deleterious effect of hyperglycemia on the myocardium, possibly reflecting a microvascular cause.
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Authors | Elizabeth Selvin, Mariana Lazo, Yuan Chen, Lu Shen, Jonathan Rubin, John W McEvoy, Ron C Hoogeveen, A Richey Sharrett, Christie M Ballantyne, Josef Coresh |
Journal | Circulation
(Circulation)
Vol. 130
Issue 16
Pg. 1374-82
(Oct 14 2014)
ISSN: 1524-4539 [Electronic] United States |
PMID | 25149362
(Publication Type: Journal Article, Research Support, N.I.H., Extramural)
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Copyright | © 2014 American Heart Association, Inc. |
Chemical References |
- Blood Glucose
- Glycated Hemoglobin A
- Troponin T
- hemoglobin A1c protein, human
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Topics |
- Blood Glucose
(metabolism)
- Coronary Artery Disease
(mortality, pathology)
- Diabetes Mellitus
(mortality)
- Female
- Follow-Up Studies
- Glycated Hemoglobin
(metabolism)
- Heart Failure
(mortality, pathology)
- Humans
- Incidence
- Male
- Middle Aged
- Myocardium
(pathology)
- Prediabetic State
(mortality)
- Proportional Hazards Models
- Risk Assessment
- Risk Factors
- Troponin T
(blood)
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