Plasma levels of high-sensitivity cardiac troponins can improve the stratification of mortality risk beyond the comorbidity burden in older adults with diabetes, according to study results published in Diabetes Care.
Guidelines from the American Diabetes Association recommend the use of comorbidity count to inform mortality risk and disease management in older adults with diabetes. However, objective approaches to this risk stratification are lacking. High-sensitivity cardiac troponins I (hs-cTnI) and T (hs-cTnT) are markers of cardiovascular morbidity and mortality. The investigators aimed to determine whether high-sensitivity cardiac troponin levels could aid in mortality risk stratification in older adults with diabetes.
The study included 1835 older adults (43% men; 31% black) with diabetes between the ages of 67 and 89 years (mean, 75.5 years) in the Atherosclerosis Risk in Communities (ARIC) Study. High comorbidity burden, defined as having ≥3 co-occurring conditions, was identified in 61% of patients.
Compared with patients with a low comorbidity burden, participants with a high comorbidity burden were more likely to have higher hs-cTnI (median, 2.8 vs 4.3 ng/L, respectively) and hs-cTnT (median, 10.0 vs 14.0 ng/L, respectively) levels. The comorbidity profile was similar between troponins and high levels of both were associated with coronary heart disease, heart failure, chronic kidney disease, emphysema or chronic obstructive pulmonary disease, hypertension, frailty, and dementia.
Over the course of follow-up (median, 6.2 years), 418 deaths occurred. Higher levels of both troponins, as well as a high comorbidity burden (hazard ratio [HR], 2.94; 95% CI, 2.25-3.85), were associated with a higher mortality risk. When considered together or independently, high troponin levels increased prognostic capabilities beyond the comorbidity burden alone. Inclusion of either troponin in survival models based on traditional risk factors and comorbidity burden predominantly reclassified patients who did not die during follow-up as lower risk for mortality.
Patients with high levels of either troponin and a high comorbidity burden were at the highest risk for mortality. Among individuals with a low comorbidity burden, high levels of hs-cTnI (HR, 3.0; 95% CI, 1.7-5.4) and hs-cTnT (HR, 3.3; 95% CI, 1.8-6.2) were still associated with an increased mortality risk.
The researchers noted that the relatively short duration of the study represented a limitation to its findings.
“Both high hs-cTnI and hs-cTnT are robustly associated with cardiovascular, respiratory, and microvascular comorbidities,” the study authors concluded. “Our findings suggest that high-sensitivity cardiac troponins could be used to improve risk characterization and inform clinical management strategies in older adults with diabetes.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Tang O, Daya N, Matsushita K, et al. Performance of high-sensitivity cardiac troponin assays to reflect comorbidity burden and improve mortality risk stratification in older adults with diabetes [published online March 11, 2020]. Diabetes Care. doi:10.2337/dc19-2043