title: Diabetes mellitus, prediabetes, and incidence of subclinical myocardial damage.
abstract: BACKGROUND
  Persons with prediabetes and diabetes mellitus are at high risk for cardiovascular events. However, the relationships of prediabetes and diabetes mellitus to the development of subclinical myocardial damage are unclear.
  
  
  RESULTS
  We measured cardiac troponin T with a highly sensitive assay (hs-cTnT) at 2 time points, 6 years apart, among 9051 participants of the community-based Atherosclerosis Risk in Communities Study with no diabetes mellitus, or prediabetes, and without cardiovascular disease including silent myocardial infarction by ECG. First, we examined the incidence of elevated hs-cTnT (≥14 ng/L) at 6 years of follow-up. Second, we examined clinical outcomes during the subsequent ≈14 years of follow-up among persons with and without incident elevations in hs-cTnT. Cumulative probabilities of elevated hs-cTnT at 6 years among persons with no diabetes mellitus, prediabetes, and diabetes mellitus were 3.7%, 6.4%, and 10.8%, respectively. Compared with normoglycemic persons, the adjusted relative risks for incident elevated hs-cTnT were 1.40 (95% CI, 1.08-1.80) for prediabetes and 2.47 (95% CI, 1.78-3.43) for diabetes mellitus. Persons with diabetes mellitus and incident elevations in hs-cTnT were at a substantially higher risk of heart failure (hazard ratio, 6.37 [95% CI, 4.27-9.51]), death (hazard ratio, 4.36 [95% CI, 3.14-6.07]), and coronary heart disease (hazard ratio, 3.84 [95% CI, 2.52-5.84]) compared with persons without diabetes mellitus and no incident elevation in hs-cTnT.
  
  
  CONCLUSIONS
  Prediabetes and diabetes mellitus were independently associated with the development of subclinical myocardial damage, as assessed by hs-cTnT, and those persons with evidence of subclinical damage were at highest risk for clinical events. These results support a possible deleterious effect of hyperglycemia on the myocardium, possibly reflecting a microvascular cause.
authors.affiliation: From the Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.S., M.L., Y.C., L.S., J.W.M., A.R.S., J.C.); Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD (E.S., M.L., J.R., J.C.); Department of Medicine, Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, TX (R.C.H., C.M.B.). eselvin@jhu.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Selvin
authors.affiliation: From the Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.S., M.L., Y.C., L.S., J.W.M., A.R.S., J.C.); Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD (E.S., M.L., J.R., J.C.); Department of Medicine, Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, TX (R.C.H., C.M.B.).
authors.forename: Mariana
authors.initials: M
authors.lastname: Lazo
authors.affiliation: From the Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.S., M.L., Y.C., L.S., J.W.M., A.R.S., J.C.); Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD (E.S., M.L., J.R., J.C.); Department of Medicine, Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, TX (R.C.H., C.M.B.).
authors.forename: Yuan
authors.initials: Y
authors.lastname: Chen
authors.affiliation: From the Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.S., M.L., Y.C., L.S., J.W.M., A.R.S., J.C.); Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD (E.S., M.L., J.R., J.C.); Department of Medicine, Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, TX (R.C.H., C.M.B.).
authors.forename: Lu
authors.initials: L
authors.lastname: Shen
authors.affiliation: From the Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.S., M.L., Y.C., L.S., J.W.M., A.R.S., J.C.); Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD (E.S., M.L., J.R., J.C.); Department of Medicine, Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, TX (R.C.H., C.M.B.).
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rubin
authors.affiliation: From the Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.S., M.L., Y.C., L.S., J.W.M., A.R.S., J.C.); Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD (E.S., M.L., J.R., J.C.); Department of Medicine, Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, TX (R.C.H., C.M.B.).
authors.forename: John W
authors.initials: JW
authors.lastname: McEvoy
authors.affiliation: From the Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.S., M.L., Y.C., L.S., J.W.M., A.R.S., J.C.); Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD (E.S., M.L., J.R., J.C.); Department of Medicine, Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, TX (R.C.H., C.M.B.).
authors.forename: Ron C
authors.initials: RC
authors.lastname: Hoogeveen
authors.affiliation: From the Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.S., M.L., Y.C., L.S., J.W.M., A.R.S., J.C.); Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD (E.S., M.L., J.R., J.C.); Department of Medicine, Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, TX (R.C.H., C.M.B.).
authors.forename: A Richey
authors.initials: AR
authors.lastname: Sharrett
authors.affiliation: From the Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.S., M.L., Y.C., L.S., J.W.M., A.R.S., J.C.); Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD (E.S., M.L., J.R., J.C.); Department of Medicine, Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, TX (R.C.H., C.M.B.).
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.affiliation: From the Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.S., M.L., Y.C., L.S., J.W.M., A.R.S., J.C.); Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD (E.S., M.L., J.R., J.C.); Department of Medicine, Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, TX (R.C.H., C.M.B.).
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D003324:Coronary Artery Disease / Q000401:mortality* / Q000473:pathology; D003920:Diabetes Mellitus / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006333:Heart Failure / Q000401:mortality* / Q000473:pathology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D011236:Prediabetic State / Q000401:mortality*; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D020107:Troponin T / Q000097:blood
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D020107:Troponin T; C517652:hemoglobin A1c protein, human
keywords: biological markers; diabetes mellitus; epidemiology; prediabetic state