title: Troponin in diabetic patients with and without chronic coronary artery disease.
abstract: BACKGROUND
  Cardiac-specific troponin detected with the new high-sensitivity assays can be chronically elevated in response to cardiovascular comorbidities and confer important prognostic information, in the absence of unstable coronary syndromes. Both diabetes mellitus and coronary artery disease are known predictors of troponin elevation. It is not known whether diabetic patients with coronary artery disease have different levels of troponin compared with diabetic patients with normal coronary arteries. To investigate this question, we determined the concentrations of a level 1 troponin assay in two groups of diabetic patients: those with multivessel coronary artery disease and those with angiographically normal coronary arteries.
  
  
  METHODS
  We studied 95 diabetic patients and compared troponin in serum samples from 50 patients with coronary artery disease (mean age = 63.7, 58 % male) with 45 controls with angiographically normal coronary arteries. Brain natriuretic peptide and the oxidative stress biomarkers myeloperoxidase, nitrotyrosine and oxidized LDL were also determined.
  
  
  RESULTS
  Diabetic patients with coronary artery disease had higher levels of troponin than did controls (median values, 12.0 pg/mL (95 % CI:10-16) vs 7.0 pg/mL (95 % CI: 5.9-8.5), respectively; p = 0.0001). The area under the ROC curve for the diagnosis of CAD was 0.712 with a sensitivity of 70 % and a specificity of 66 %. Plasma BNP levels and oxidative stress variables (myeloperoxidase, nitrotyrosine, and oxidized LDL) were not different between the two groups. In a multivariate analysis, gender (p = 0.04), serum glucose (0.03) and Troponin I (p = 0.01) had independent statistical significance.
  
  
  CONCLUSIONS
  Troponin elevation is related to the presence of chronic coronary artery disease in diabetic patients with multiple associated cardiovascular risk factors. Troponin may serve as a biomarker in this high-risk population.
  
  
  BACKGROUND
  http://www.controlled-trials.com
  
  
  BACKGROUND
  ISRCTN26970041.
authors.affiliation: Department of Clinical Cardiology, Heart Institute (InCor) University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, BL I, Sala 114, Cerqueira César, Sao Paulo, SP, 05403-000, Brazil. alexandre.segre@terra.com.br.
authors.forename: Carlos Alexandre Wainrober
authors.initials: CA
authors.lastname: Segre
authors.affiliation: Department of Clinical Cardiology, Heart Institute (InCor) University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, BL I, Sala 114, Cerqueira César, Sao Paulo, SP, 05403-000, Brazil. whady.hueb@incor.usp.br.
authors.forename: Whady
authors.initials: W
authors.lastname: Hueb
authors.affiliation: Department of Clinical Cardiology, Heart Institute (InCor) University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, BL I, Sala 114, Cerqueira César, Sao Paulo, SP, 05403-000, Brazil. rosarahmi@gmail.com.
authors.forename: Rosa Maria Rahmi
authors.initials: RM
authors.lastname: Garcia
authors.affiliation: Department of Clinical Cardiology, Heart Institute (InCor) University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, BL I, Sala 114, Cerqueira César, Sao Paulo, SP, 05403-000, Brazil. rezendepaulo@hotmail.com.
authors.forename: Paulo Cury
authors.initials: PC
authors.lastname: Rezende
authors.affiliation: Department of Clinical Cardiology, Heart Institute (InCor) University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, BL I, Sala 114, Cerqueira César, Sao Paulo, SP, 05403-000, Brazil. desideriofavarato2010@gmail.com.
authors.forename: Desiderio
authors.initials: D
authors.lastname: Favarato
authors.affiliation: Department of Clinical Cardiology, Heart Institute (InCor) University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, BL I, Sala 114, Cerqueira César, Sao Paulo, SP, 05403-000, Brazil. labcelia@incor.usp.br.
authors.forename: Celia Maria Cassaro
authors.initials: CM
authors.lastname: Strunz
authors.affiliation: Department of Clinical Cardiology, Heart Institute (InCor) University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, BL I, Sala 114, Cerqueira César, Sao Paulo, SP, 05403-000, Brazil. marilia_coliveira@yahoo.com.br.
authors.forename: Marília da Costa Oliveira
authors.initials: Mda C
authors.lastname: Sprandel
authors.affiliation: Department of Clinical Cardiology, Heart Institute (InCor) University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, BL I, Sala 114, Cerqueira César, Sao Paulo, SP, 05403-000, Brazil. alessandra.roggerio@incor.usp.br.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Roggério
authors.affiliation: Department of Clinical Cardiology, Heart Institute (InCor) University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, BL I, Sala 114, Cerqueira César, Sao Paulo, SP, 05403-000, Brazil. analuacatita@hotmail.com.
authors.forename: Ana Luiza de Oliveira
authors.initials: AL
authors.lastname: Carvalho
authors.affiliation: Department of Clinical Cardiology, Heart Institute (InCor) University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, BL I, Sala 114, Cerqueira César, Sao Paulo, SP, 05403-000, Brazil. ramarans@usp.br.
authors.forename: Raul Cavalcante
authors.initials: RC
authors.lastname: Maranhão
authors.affiliation: Department of Clinical Cardiology, Heart Institute (InCor) University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, BL I, Sala 114, Cerqueira César, Sao Paulo, SP, 05403-000, Brazil. jramires@incor.usp.br.
authors.forename: José Antonio Franchini
authors.initials: JA
authors.lastname: Ramires
authors.affiliation: Department of Clinical Cardiology, Heart Institute (InCor) University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, BL I, Sala 114, Cerqueira César, Sao Paulo, SP, 05403-000, Brazil. roberto.kalil@incor.usp.br.
authors.forename: Roberto
authors.initials: R
authors.lastname: Kalil Filho
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D008078:Cholesterol, LDL / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010084:Oxidation-Reduction; D009195:Peroxidase / Q000097:blood; D012307:Risk Factors; D019209:Troponin C / Q000097:blood*; D014443:Tyrosine / Q000031:analogs & derivatives / Q000097:blood
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL; D019209:Troponin C; D020097:Natriuretic Peptide, Brain; C002744:3-nitrotyrosine; D014443:Tyrosine; D009195:Peroxidase