Colombo M, et al. - Five candidate biomarkers, yielded by an earlier discovery study, were tested for the ability to predict incident cardiovascular disease (CVD) in type 2 diabetes. N-terminal prohormone B-type natriuretic peptide (NT-proBNP) and apolipoprotein CIII (apoCIII) provided a substantial increase in the prediction of CVD in type 2 diabetes beyond that seen with the variables used in the Framingham risk score.

Methods

• Baseline serum samples from the Collaborative Atorvastatin Diabetes trial (CARDS) of atorvastatin vs placebo were collected.
• These samples were used to measure apolipoprotein CIII (apoCIII), N-terminal prohormone B-type natriuretic peptide (NT-proBNP), high sensitivity Troponin T (hsTnT), interleukin-6 and interleukin-15.
• Study included a total of 2,105 persons with type 2 diabetes and a median age of 62.9 years (range 39.2–77.3), and there were 144 incident CVD (acute coronary heart disease or stroke) cases reported during the maximum 5-year follow up.
• Using Cox Proportional Hazards models, researchers determined biomarkers related to incident CVD and the area under the receiver operating characteristic curves (AUROC) to evaluate overall model prediction.

Results

• Independently of other risk factors, the following three biomarkers were found to be singly related to incident CVD: NT-proBNP (hazard ratio per standardized unit 2.02, 95% confidence interval [CI] 1.63, 2.50), apoCIII (1.34, 95% CI 1.12, 1.60) and hsTnT (1.40, 95% CI 1.16, 1.69).
• Researchers found that when combined in a single model, only NT-proBNP and apoCIII were identified as independent predictors of CVD, together increasing the AUROC using Framingham risk variables from 0.661 to 0.745.