title: Detectable subclinical myocardial necrosis is associated with cardiovascular risk in stable patients with diabetes.
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.
  
  
  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.
authors: Cleveland Clinic,Cleveland, OH, USA. tangw@ccf.org
authors: W H Wilson
authors: WH
authors: Tang
authors: Yuping
authors: Y
authors: Wu
authors: Earl B
authors: EB
authors: Britt
authors: Naveed
authors: N
authors: Iqbal
authors: Stanley L
authors: SL
authors: Hazen
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood* / Q000378:metabolism; D003920:Diabetes Mellitus / Q000097:blood* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000378:metabolism; D012307:Risk Factors; D019210:Troponin I / Q000097:blood
chemical_list: D001786:Blood Glucose; D019210:Troponin I; D002097:C-Reactive Protein
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