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Cardiac dysfunction may predict mortality in type 2 diabetes, acute coronary syndrome
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Compared with markers of metabolic dysfunction, markers of cardiac dysfunction may be more effective in predicting the risk for mortality in adults with type 2 diabetes and recent acute coronary syndrome, study data show.
Stefano Savonitto, MD, of the division of cardiology at Ospedale Alessandro Manzoni in Italy, and colleagues evaluated data from the AleCardio trial on 7,226 adults (mean age, 60 years; 72.8% men; 66.6% white) with type 2 diabetes and recent acute coronary syndrome to determine the predictors of long-term mortality among them. Follow-up was a median 2 years.
In the AleCardio trial, participants were randomly assigned to placebo or the dual peroxisome proliferator-activated receptor agonist aleglitazar to test cardiovascular outcomes.
At the end of follow-up, of the 4% of participants who died, 73.4% were from CV causes, for an incident rate of two events per 100 person-years.
The prediction model included N-terminal pro-B-type natriuretic peptide (NT-proBNP), coronary revascularization, age, heart rate, HbA1c, hemoglobin, prior coronary artery bypass and prior myocardial infarction.
NT-proBNP was the greatest predictor of mortality (27% of prediction), followed by lack of coronary revascularization (18%), each 1-year increase in age (15%), each 1-point increase in heart rate (10%), each 1% increase in HbA1c (8%), each 1 g/dL decrease in hemoglobin (8%), prior coronary artery bypass (7%) and prior MI (6%).
“A meaningful and parsimonious set of clinical and laboratory variables may assist clinicians in risk stratification of patients with diabetes discharged after an acute coronary syndrome,” the researchers wrote. “Besides patient age, these variables represent the burden of cardiovascular and other end-organ damage associated to diabetes mellitus. The variables entered in the model are readily available in the common clinical setting and will allow better management of these high-risk patients during their follow-up.” – by Amber Cox
Disclosures: The authors report no relevant financial disclosures.
Perspective
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The results are important and reinforce that heart disease-related predictors are more important than metabolic parameters in predicting all-cause mortality, 70% of which was CVD mortality, in patients with type 2 diabetes 2 years after a stable period of less than 12 weeks after an admission with an acute coronary syndrome. Of note, NT-proBNP was the most powerful predictor and suggests that diagnosed or undiagnosed congestive heart failure was relevant; however, only 50% of patients had assessments of left ventricular failure. Elevated heart rate, age and anemia were all in the model and related to the outcome. However, of great interest was the important contribution of lack of coronary revascularization; this was second only to NT-proBNP. The benefit of coronary vascularization in patients with type 2 diabetes is a familiar story. HbA1c also contributed but explained only 8% of the risk, so let’s not dismiss this entirely.
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