Background

Based on the complex pathophysiology of type 2 diabetes and atherosclerosis we hypothesized a dynamic change in prognostic value of cardiovascular biomarkers over time.

Methods

In this prospective study 746 patients with type 2 diabetes mellitus, being followed up for 60 months were analysed. The primary endpoint was defined as unplanned hospitalization for cardiovascular disease or death. Beside others, especially the prognostic performance of the biomarkers of interest (GDF-15, NT-proBNP, hs-TnT) was evaluated in relation to quartiles of diabetes duration.

Results

In patients having a diabetes duration below 7 years lnGDF-15 (HR 2.84; p < 0.01) and lnhs-TnT (HR 2.96; p < 0.01) were significant predictors of the primary endpoint. LnAge (HR 40.01; p < 0.01) and lnNT-proBNP (HR 1.56; p = 0.03) were significant predictors in patients with a diabetes duration between 7 and 12 years. In the third quartile (diabetes duration 12–22 years) lnurinary albumin to creatinine ratio (HR 1.25; p = 0.005) and lnNT-proBNP (HR 2.13, p < 0.001) predicted the endpoint. In patients with a diabetes duration above 22 years, lnAge (HR 75.35; p = 0.001) and lnNT-proBNP (HR 2.0; p < 0.01) were the only significant predictors of the endpoint.

Conclusion

Prognostic power of cardiovascular biomarkers changes dynamically in relation to duration of type 2 diabetes mellitus. In patients with shorter duration of the disease markers of subclinical cardiovascular dysfunction and inflammation perform better than markers of systemic advanced organ dysfunction and cardiovascular disease.

中文翻译：

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现代心血管生物标志物与糖尿病病程相关的预后价值变化

背景

基于 2 型糖尿病和动脉粥样硬化的复杂病理生理学，我们假设心血管生物标志物的预后价值随时间发生动态变化。

方法

在这项前瞻性研究中，对 746 名 2 型糖尿病患者进行了分析，随访时间为 60 个月。主要终点定义为因心血管疾病或死亡意外住院。除此之外，特别是对与糖尿病病程四分位数相关的目标生物标志物（GDF-15、NT-proBNP、hs-TnT）的预后表现进行了评估。

结果

在糖尿病病程低于 7 年的患者中，lnGDF-15 (HR 2.84; p  < 0.01) 和 lnhs-TnT (HR 2.96; p < 0.01) 是主要终点的重要预测因子。LnAge (HR 40.01; p < 0.01) 和 lnNT-proBNP (HR 1.56; p  = 0.03) 是糖尿病病程 7 至 12 年患者的重要预测因子。在第三个四分位数（糖尿病病程 12-22 年）中，尿白蛋白与肌酐比值（HR 1.25；p  = 0.005）和 lnNT-proBNP（HR 2.13，p  < 0.001）预测了终点。在糖尿病病程超过 22 年的患者中，lnAge (HR 75.35; p  = 0.001) 和 lnNT-proBNP (HR 2.0; p  < 0.01) 是唯一重要的终点预测因子。

结论

心血管生物标志物的预后能力与 2 型糖尿病的持续时间有关。在病程较短的患者中，亚临床心血管功能障碍和炎症标志物的表现优于全身性晚期器官功能障碍和心血管疾病标志物。