Document Type
Article
Publication Date
5-1-2013
Publication Title
Diabetes Care
Abstract
OBJECTIVE: To investigate the relationship between different degrees of subclinical myocardial necrosis, glycemic control, and long-term adverse clinical outcomes within a stable patient population with diabetes mellitus. RESEARCH DESIGN AND METHODS: We examined 1,275 stable patients with diabetes mellitus undergoing elective diagnostic coronary angiography with cardiac troponin I (cTnI) levels below the diagnostic cut-off for defining myocardial infarction (MI) (<0.03 ng/mL). The relationship of subclinical myocardial necrosis (cTnI 0.009–0.029 ng/mL) with incident major adverse cardiovascular events (MACE; defined as any death, MI, or stroke) over 3 years of follow-up was examined. RESULTS: Subclinical myocardial necrosis was observed in 22% of patients. A strong association was observed between the magnitude of subclinical myocardial necrosis and risk of 3-year incident MACE (hazard ratio, 1.98; 95% confidence interval, 1.48–2.65; P < 0.001) and remained statistically significant even after adjustment for traditional risk factors, high-sensitivity C-reactive protein, and creatinine clearance. Only a weak correlation was observed between the presence of subclinical myocardial necrosis and either glycemic control (r = 0.06; P = 0.044 for hemoglobin A1c versus cTnI) or insulin resistance (r = 0.04; P = 0.094 for glucose-to-insulin ratio versus cTnI). CONCLUSIONS: The presence of detectable subclinical myocardial necrosis in stable patients with diabetes mellitus is associated with heightened long-term risk for MACE, independent of traditional risk factors and glycemic control.
Repository Citation
Tang, W.H. Wilson; Wu, Yuping; Britt, Earl B. Jr.; Iqbal, Naveed; and Hazen, Stanley L., "Detectable Subclinical Myocardial Necrosis Is Associated With Cardiovascular Risk in Stable Patients With Diabetes" (2013). Mathematics and Statistics Faculty Publications. 181.
https://engagedscholarship.csuohio.edu/scimath_facpub/181
DOI
10.2337/dc11-1969
Version
Postprint
Publisher's Statement
The American Diabetes Association holds copyright on all content published in ADA Journals, unless otherwise noted. Readers may use the content as long as the work is properly cited and linked to the original source, the use is educational and not for profit, and the work is not altered. ADA journals articles may not be included without ADA permission in educational materials that are sold to students or used in courses for which tuition or other fees are charged.
Volume
36
Issue
5
Comments
This research was supported by National Institutes of Health grants P01HL076491, P01HL103453, P01HL098055, R01HL103866, R01HL103931, and P20HL113452 and by the Cleveland Clinic Clinical Research Unit of the Case Western Reserve University CTSA (UL1TR 000439-06).