Cardiac Biomarkers May Predict Risk of CV Mortality, HF Hospitalization

Individuals with higher levels of N-terminal pro b-type natriuretic peptide (NT-proBNP) or high-sensitivity troponin T (hsTnT) have an increased risk for cardiovascular (CV)-related mortality and heart failure (HF)-related hospitalization, according to a new study presented at the American Heart Association Scientific Sessions 2019. However, dapagliflozin can reduce these risks.

To reach these conclusions, the researchers assessed results of a prespecified biomarker study from the Dapagliflozin Effect on Cardiovascular Events-Thrombolysis in Myocardial Infarction (DECLARE-TIMI 58) trial, which analyzed the association between CV outcomes and dapagliflozin use in patients with type 2 diabetes.

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The baseline NT-proBNP and hsTnT levels of 14,565 participants were analyzed, and the participants were stratified by their baseline biomarker levels. 

The median baseline NT-proBNP level was 75 pg/mL, and the median baseline hsTnT level was 10.2 pg/mL.

Within each of the biomarker quartiles, hazard ratios were used to determine the relative risk ratios and Kaplan-Meier event rates were used to determine absolute risk reductions after 4 years of dapagliflozin use.

The researchers determined that participants who had higher levels of the 2 biomarkers had higher Kaplan-Meier event rates for both CV mortality and HF hospitalization. 

The Kaplan-Meier event rate for CV mortality was 13.7% among those with the highest levels of NT-proBNP vs 1.0% among those with the lowest levels of the biomarker. Meanwhile, the Kaplan-Meier event rate for HF hospitalization was 11.8% among those with the highest levels of hsTnT vs 1.4% among those with the lowest levels of the biomarker.

However, regardless of the baseline NT-proBNP or hsTnT quartiles, dapagliflozin consistently reduced the relative risk of CV mortality and HF hospitalization; those who had elevated levels of NT-proBNP and/or hsTnT at baseline tended to have an even greater reduction in absolute risk of the 2 outcomes.

—Colleen Murphy

Reference:

Zelniker TA, Morrow DA, Mosenzon O, et al; TIMI Study Group. Relationship between baseline cardiac biomarkers and cardiovascular death or hospitalization for heart failure in DECLARE-TIMI 58. Paper presented at: American Heart Association Scientific Sessions 2019; November 16-18, 2019; Philadelphia, PA. https://www.abstractsonline.com/pp8/#!/7891/presentation/32041. Accessed November 18, 2019.