TY - JOUR
T1 - Performance of high-sensitivity cardiac troponin assays to reflect comorbidity burden and improve mortality risk stratification in older adults with diabetes
AU - Tang, Olive
AU - Daya, Natalie
AU - Matsushita, Kunihiro
AU - Coresh, Josef
AU - Richey Sharrett, A.
AU - Hoogeveen, Ron
AU - Jia, Xiaoming
AU - Gwen Windham, B.
AU - Ballantyne, Christie
AU - Selvin, Elizabeth
N1 - Funding Information:
The content of this work is solely the responsibility of the authors and does not necessarily represent the official views of NIH. Duality of Interest. K.M. has received nonfinancial support from Roche Diagnostics outside this work. R.H. has received grant support and consulting fees from Denka Seiken outside the submitted work. R.H. and C.B. are coinventors on a provisional patent (#61721475) titled Biomarkers To Improve Prediction of Heart Failure Risk filed by Roche Diagnostics and Baylor College of Medicine on their behalf. C.B. receives grant/ research support from Abbott Diagnostics, Roche Diagnostics, and NIH and is a consultant for Abbott Diagnostics and Roche Diagnostics. E.S. has served on the advisory board for Roche Diagnostics. No other potential conflicts of interest relevant to this article were reported. Author Contributions. O.T. and N.D. conducted the analyses. O.T., N.D., K.M., J.C., A.R.S., R.H., X.J., B.G.W., C.B., and E.S. provided data interpretation and meaningful contributions to the revision of the manuscript. O.T. and E.S. designed the study and drafted the manuscript. O.T. and E.S. are the guarantors of this work and, as such, had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Prior Presentation. Parts of this study were presented in abstract form at the 3rd Annual Heart in Diabetes Conference, Philadelphia, PA, 12–14 July 2019.
Funding Information:
Registries of the Centers for Disease Control and Prevention for the funds that helped to support the availability of the cancer registry data. Neuro-cognitive data are collected by NIH (NHLBI, National Institute of Neurological Disorders and Stroke, National Institute on Aging, and National Institute on Deafness and Other Communication Disorders) grants U01-2U01-HL-096812, 2U01-HL-096814, 2U01-HL-096899, 2U01-HL-096902, and 2U01-HL-096917 and with previous brain MRI examinations funded by NHLBI grant R01-HL-70825. O.T. is supported by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grant F30-DK-120160. C.B. is supported by NHLBI grant R01-HL-134320. E.S. is supported by NIDDK grants K24-DK-106414 and R01-DK-089174. Reagents for the hs-cTnT assay were donated by Roche Diagnostics, and reagents for the hs-cTnI assay were donated by Abbott Diagnostics.
Funding Information:
The authors thank the staff and participants of the ARIC Study for indispensable contributions. The ARIC Study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Department of Health and Human Services, under contract numbers HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, and HHSN268201700005I. Studies on cancer in ARIC are also supported by the National Cancer Institute (U01-CA-164975). Cancer incidence data have been provided by the Maryland Cancer Registry, Center for Cancer Surveillance and Control, Department of Mental Health and Hygiene. The authors acknowledge the State of Maryland, the Maryland Cigarette Restitution Fund, and the National Program of Cancer Registries of the Centers for Disease Control and Prevention for the funds that helped to support the availability of the cancer registry data. Neurocognitive data are collected by NIH (NHLBI, National Institute of Neurological Disorders and Stroke, National Institute on Aging, and National Institute on Deafness and Other Communication Disorders) grants U01-2U01-HL-096812, 2U01-HL-096814, 2U01-HL-096899, 2U01-HL-096902, and 2U01-HL-096917 and with previous brain MRI examinations funded by NHLBI grant R01-HL-70825. O.T. is supported by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grant F30-DK-120160. C.B. is supported by NHLBI grant R01-HL-134320. E.S. is supported by NIDDK grants K24-DK-106414 and R01-DK-089174. Reagents for the hs-cTnT assay were donated by Roche Diagnostics, and reagents for the hs-cTnI assay were donated by Abbott Diagnostics.
Funding Information:
Acknowledgments. The authors thank the staff and participants of the ARIC Study for indispensable contributions. Funding. The ARIC Study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Department of Health and Human Services, under contract numbers HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, and HHSN268201700005I. Studies on cancer in ARIC are also supported by the National Cancer Institute (U01-CA-164975). Cancer incidence data have been provided by the Maryland Cancer Registry, Center for Cancer Surveillance and Control, Department of Mental Health and Hygiene. The authors acknowledge the State of Maryland, the Maryland Cigarette Restitution Fund, and the National Program of Cancer
Publisher Copyright:
© 2020 by the American Diabetes Association.
PY - 2020/6/1
Y1 - 2020/6/1
N2 - OBJECTIVE Incorporation of comorbidity burden to inform diabetes management in older adults remains challenging. High-sensitivity cardiac troponins are objective, quantifiable biomarkers that may improve risk monitoring in older adults. We assessed the associations of elevations in high-sensitivity cardiac troponin I (hs-cTnI) and T (hs-cTnT) with comorbidities and improvements in mortality risk stratification. RESEARCH DESIGN AND METHODS We used logistic regression to examine associations of comorbidities with elevations in either troponin (‡85th percentile) among 1,835 participants in the Atherosclerosis Risk in Communities (ARIC) Study with diabetes (ages 67–89 years, 43% male, 31% black) at visit 5 (2011–2013). We used Cox models to compare associations of high cardiac troponins with mortality across comorbidity levels. RESULTS Elevations in either troponin (‡9.4 ng/L for hs-cTnI, ‡25 ng/L for hs-cTnT) were associated with prevalent coronary heart disease, heart failure, chronic kidney disease, pulmonary disease, hypoglycemia, hypertension, dementia, and frailty. Over a median follow-up of 6.2 years (418 deaths), both high hs-cTnI and high hs-cTnT further stratified mortality risk beyond comorbidity levels; those with a high hs-cTnI or hs-cTnT and high comorbidity were at highest mortality risk. Even among those with low comorbidity, a high hs-cTnI (hazard ratio 3.0 [95% CI 1.7, 5.4]) or hs-cTnT (hazard ratio 3.3 [95% CI 1.8, 6.2]) was associated with elevated mortality. CONCLUSIONS Many comorbidities were reflected by both hs-cTnI and hs-cTnT; elevations in either of the troponins were associated with higher mortality risk beyond comorbidity burden. High-sensitivity cardiac troponins may identify older adults at high mortality risk and be useful in guiding clinical care of older adults with diabetes.
AB - OBJECTIVE Incorporation of comorbidity burden to inform diabetes management in older adults remains challenging. High-sensitivity cardiac troponins are objective, quantifiable biomarkers that may improve risk monitoring in older adults. We assessed the associations of elevations in high-sensitivity cardiac troponin I (hs-cTnI) and T (hs-cTnT) with comorbidities and improvements in mortality risk stratification. RESEARCH DESIGN AND METHODS We used logistic regression to examine associations of comorbidities with elevations in either troponin (‡85th percentile) among 1,835 participants in the Atherosclerosis Risk in Communities (ARIC) Study with diabetes (ages 67–89 years, 43% male, 31% black) at visit 5 (2011–2013). We used Cox models to compare associations of high cardiac troponins with mortality across comorbidity levels. RESULTS Elevations in either troponin (‡9.4 ng/L for hs-cTnI, ‡25 ng/L for hs-cTnT) were associated with prevalent coronary heart disease, heart failure, chronic kidney disease, pulmonary disease, hypoglycemia, hypertension, dementia, and frailty. Over a median follow-up of 6.2 years (418 deaths), both high hs-cTnI and high hs-cTnT further stratified mortality risk beyond comorbidity levels; those with a high hs-cTnI or hs-cTnT and high comorbidity were at highest mortality risk. Even among those with low comorbidity, a high hs-cTnI (hazard ratio 3.0 [95% CI 1.7, 5.4]) or hs-cTnT (hazard ratio 3.3 [95% CI 1.8, 6.2]) was associated with elevated mortality. CONCLUSIONS Many comorbidities were reflected by both hs-cTnI and hs-cTnT; elevations in either of the troponins were associated with higher mortality risk beyond comorbidity burden. High-sensitivity cardiac troponins may identify older adults at high mortality risk and be useful in guiding clinical care of older adults with diabetes.
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U2 - 10.2337/dc19-2043
DO - 10.2337/dc19-2043
M3 - Article
C2 - 32161049
AN - SCOPUS:85085265995
VL - 43
SP - 1200
EP - 1208
JO - Diabetes Care
JF - Diabetes Care
SN - 1935-5548
IS - 6
ER -