title: High-sensitive troponin T is associated with all-cause and cardiovascular mortality in stable outpatients with type 2 diabetes (ZODIAC-37).
abstract: BACKGROUND
  We aimed to investigate whether high-sensitive cardiac troponin T (hs-cTnT) is associated with all-cause and cardiovascular mortality in stable type 2 diabetes (T2D) outpatients treated in primary care.
  
  
  METHODS
  Cardiac troponin T was measured with a high-sensitive assay at baseline in patients with T2D participating in the observational ZODIAC study. Cox proportional hazards models were used to investigate the relationship between hs-cTnT and mortality with adjustment for selected confounders. Risk prediction capabilities of hs-cTnT were assessed with Harrell C statistics.
  
  
  RESULTS
  Complete baseline data were available for 1,133 patients. During median follow-up of 11 (7-14) years, 513 (45%) patients died, of which 218 (42%) died of cardiovascular causes. Of the patients with undetectable hs-cTnT levels (<3 ng/L), only 23% died, compared with 58% with low detectable levels (3-14 ng/L) and 84% with raised levels (≥14 ng/L). Natural log hs-cTnT was significantly associated with all-cause mortality (hazard ratio 1.30, 95% CI 1.19-1.42) and cardiovascular mortality (hazard ratio 1.33, 95% CI 1.15-1.53), independent of potential confounders. The Harrell C statistic for the crude model of hs-cTnT was 0.72 (95% CI 0.70-0.75) for all-cause mortality and 0.74 (95% CI 0.71-0.77) for cardiovascular mortality.
  
  
  CONCLUSIONS
  Higher levels of hs-cTnT are associated with mortality in stable outpatients with T2D. The high crude Harrell C values and the excellent prognosis of patients with undetectable levels illustrate the strength of hs-cTnT as a potential marker for mortality.
authors.affiliation: Diabetes Centre, Isala, Zwolle, the Netherlands. Electronic address: s.hendriks@isala.nl.
authors.forename: Steven H
authors.initials: SH
authors.lastname: Hendriks
authors.affiliation: Diabetes Centre, Isala, Zwolle, the Netherlands.
authors.forename: Peter R
authors.initials: PR
authors.lastname: van Dijk
authors.affiliation: Diabetes Centre, Isala, Zwolle, the Netherlands.
authors.forename: Kornelis J J
authors.initials: KJ
authors.lastname: van Hateren
authors.affiliation: Department of Clinical Chemistry, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
authors.forename: Joost L
authors.initials: JL
authors.lastname: van Pelt
authors.affiliation: Diabetes Centre, Isala, Zwolle, the Netherlands; Department of General Practice, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands.
authors.forename: Klaas H
authors.initials: KH
authors.lastname: Groenier
authors.affiliation: Diabetes Centre, Isala, Zwolle, the Netherlands; Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands; Department of Internal Medicine, Isala, Zwolle, the Netherlands.
authors.forename: Henk J G
authors.initials: HJ
authors.lastname: Bilo
authors.affiliation: Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands.
authors.forename: Stephan J L
authors.initials: SJ
authors.lastname: Bakker
authors.affiliation: Diabetes Centre, Isala, Zwolle, the Netherlands; Department of Internal Medicine, Gelre hospital, Apeldoorn, the Netherlands.
authors.forename: Gijs W D
authors.initials: GW
authors.lastname: Landman
authors.affiliation: Diabetes Centre, Isala, Zwolle, the Netherlands; Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands; Langerhans Medical Research Group, Zwolle, the Netherlands.
authors.forename: Nanne
authors.initials: N
authors.lastname: Kleefstra
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology / Q000401:mortality*; D002423:Cause of Death / Q000639:trends; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010045:Outpatients; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D020107:Troponin T