Cardiac Biomarkers in Youth with Type 2 Diabetes Mellitus: Results from the TODAY Study
Samuel S Gidding, Fida Bacha, Petter Bjornstad, Lorraine E Levitt Katz, Lynne L Levitsky, Jane Lynch, Jeanie B Tryggestad, Ruth S Weinstock, Laure El Ghormli, Joao A C Lima, TODAY Study Group, S McKay, M Haymond, B Anderson, C Bush, S Gunn, H Holden, S M Jones, G Jeha, S McGirk, S Thamotharan, L Cuttler, E Abrams, T Casey, W Dahms, C Ievers-Landis, B Kaminski, M Koontz, S MacLeish, P McGuigan, S Narasimhan, M Geffner, V Barraza, N Chang, B Conrad, D Dreimane, S Estrada, L Fisher, E Fleury-Milfort, S Hernandez, B Hollen, F Kaufman, E Law, V Mansilla, D Miller, C Muñoz, R Ortiz, A Ward, K Wexler, Y K Xu, P Yasuda, L Levitt Katz, R Berkowitz, S Boyd, B Johnson, J Kaplan, C Keating, C Lassiter, T Lipman, G McGinley, H McKnight, B Schwartzman, S Willi, S Arslanian, F Bacha, S Foster, B Galvin, T Hannon, A Kriska, I Libman, M Marcus, K Porter, T Songer, E Venditti, R Goland, D Gallagher, P Kringas, N Leibel, D Ng, M Ovalles, D Seidman, L Laffel, A Goebel-Fabbri, M Hall, L Higgins, J Keady, M Malloy, K Milaszewski, L Rasbach, D M Nathan, A Angelescu, L Bissett, C Ciccarelli, L Delahanty, V Goldman, O Hardy, M Larkin, L Levitsky, R McEachern, D Norman, D Nwosu, S Park-Bennett, D Richards, N Sherry, B Steiner, S Tollefsen, S Carnes, D Dempsher, D Flomo, T Whelan, B Wolff, R Weinstock, D Bowerman, S Bristol, J Bulger, J Hartsig, R Izquierdo, J Kearns, R Saletsky, P Trief, P Zeitler, N Abramson, A Bradhurst, N Celona-Jacobs, J Higgins, M Kelsey, G Klingensmith, K Nadeau, T Witten, K Copeland, E Boss, R Brown, J Chadwick, L Chalmers, S Chernausek, A Hebensperger, C Macha, R Newgent, A Nordyke, D Olson, T Poulsen, L Pratt, J Preske, J Schanuel, S Sternlof, J Lynch, N Amodei, R Barajas, C Cody, D Hale, J Hernandez, C Ibarra, E Morales, S Rivera, G Rupert, A Wauters, N White, A Arbeláez, D Flomo, J Jones, T Jones, M Sadler, M Tanner, A Timpson, R Welch, S Caprio, M Grey, C Guandalini, S Lavietes, P Rose, A Syme, W Tamborlane, K Hirst, S Edelstein, P Feit, N Grover, C Long, L Pyle, B Linder, S M Marcovina, J Harting, J Shepherd, B Fan, L Marquez, M Sherman, J Wang, M Nichols, E Mayer-Davis, Y Liu, J Lima, S Gidding, J Puccella, E Ricketts, R Danis, A Domalpally, A Goulding, S Neill, P Vargo, D Wilfley, D Aldrich-Rasche, K Franklin, C Massmann, D O'Brien, J Patterson, T Tibbs, D Van Buren, M Palmert, R Ratner, D Dremaine, J Silverstein, Samuel S Gidding, Fida Bacha, Petter Bjornstad, Lorraine E Levitt Katz, Lynne L Levitsky, Jane Lynch, Jeanie B Tryggestad, Ruth S Weinstock, Laure El Ghormli, Joao A C Lima, TODAY Study Group, S McKay, M Haymond, B Anderson, C Bush, S Gunn, H Holden, S M Jones, G Jeha, S McGirk, S Thamotharan, L Cuttler, E Abrams, T Casey, W Dahms, C Ievers-Landis, B Kaminski, M Koontz, S MacLeish, P McGuigan, S Narasimhan, M Geffner, V Barraza, N Chang, B Conrad, D Dreimane, S Estrada, L Fisher, E Fleury-Milfort, S Hernandez, B Hollen, F Kaufman, E Law, V Mansilla, D Miller, C Muñoz, R Ortiz, A Ward, K Wexler, Y K Xu, P Yasuda, L Levitt Katz, R Berkowitz, S Boyd, B Johnson, J Kaplan, C Keating, C Lassiter, T Lipman, G McGinley, H McKnight, B Schwartzman, S Willi, S Arslanian, F Bacha, S Foster, B Galvin, T Hannon, A Kriska, I Libman, M Marcus, K Porter, T Songer, E Venditti, R Goland, D Gallagher, P Kringas, N Leibel, D Ng, M Ovalles, D Seidman, L Laffel, A Goebel-Fabbri, M Hall, L Higgins, J Keady, M Malloy, K Milaszewski, L Rasbach, D M Nathan, A Angelescu, L Bissett, C Ciccarelli, L Delahanty, V Goldman, O Hardy, M Larkin, L Levitsky, R McEachern, D Norman, D Nwosu, S Park-Bennett, D Richards, N Sherry, B Steiner, S Tollefsen, S Carnes, D Dempsher, D Flomo, T Whelan, B Wolff, R Weinstock, D Bowerman, S Bristol, J Bulger, J Hartsig, R Izquierdo, J Kearns, R Saletsky, P Trief, P Zeitler, N Abramson, A Bradhurst, N Celona-Jacobs, J Higgins, M Kelsey, G Klingensmith, K Nadeau, T Witten, K Copeland, E Boss, R Brown, J Chadwick, L Chalmers, S Chernausek, A Hebensperger, C Macha, R Newgent, A Nordyke, D Olson, T Poulsen, L Pratt, J Preske, J Schanuel, S Sternlof, J Lynch, N Amodei, R Barajas, C Cody, D Hale, J Hernandez, C Ibarra, E Morales, S Rivera, G Rupert, A Wauters, N White, A Arbeláez, D Flomo, J Jones, T Jones, M Sadler, M Tanner, A Timpson, R Welch, S Caprio, M Grey, C Guandalini, S Lavietes, P Rose, A Syme, W Tamborlane, K Hirst, S Edelstein, P Feit, N Grover, C Long, L Pyle, B Linder, S M Marcovina, J Harting, J Shepherd, B Fan, L Marquez, M Sherman, J Wang, M Nichols, E Mayer-Davis, Y Liu, J Lima, S Gidding, J Puccella, E Ricketts, R Danis, A Domalpally, A Goulding, S Neill, P Vargo, D Wilfley, D Aldrich-Rasche, K Franklin, C Massmann, D O'Brien, J Patterson, T Tibbs, D Van Buren, M Palmert, R Ratner, D Dremaine, J Silverstein
Abstract
Objectives: To examine cardiac biomarkers over time in youth-onset type 2 diabetes, and relate serum concentrations to cardiovascular disease risk factors, and left ventricular structure and function.
Study design: TODAY (Treatment Options for type 2 Diabetes in Adolescents and Youth) was a multicenter randomized trial of 3 treatments including 521 participants with type 2 diabetes, aged 10-17 years, and with 2-6 years of follow-up. Participants were 36% male, obese, and ethnically diverse. Annual serum concentrations of brain natriuretic peptide, troponin, tumor necrosis factor (TNF)-α, receptors 1 and 2 were related to blood pressure, body mass index, hemoglobin A1c, and left ventricular ejection fraction, diastolic function, relative wall thickness, and mass.
Results: Elevated concentrations of brain natriuretic peptide (≥100 pg/mL), TNF-α (≥5.6 pg/mL) and troponin (≥0.01 ng/mL), were present in 17.8%, 18.3%, and 34.2% of the cohort, respectively, at baseline, and in 15.4%, 17.1%, and 31.1% at the end of the study, with wide variability over time, without persistence in individuals or clear relationship to glycemia or cardiovascular structure/function. TNF receptors concentrations were increased at baseline and not significantly different from end-of-study concentrations. Adverse echocardiographic measures were more likely in the highest TNF receptor tertile (all P < .05): higher left ventricular mass (39.3 ± 9.0 g/m2.7), left atrial internal dimension (3.7 ± 0.4 cm) and E/Em ratio, a measure of diastolic dysfunction (6.2 ± 1.9). After adjustment for body mass index, these relationships were no longer significant.
Conclusions: Elevated serum concentrations of cardiac biomarkers were common in youth with type 2 diabetes, but their clinical significance is unclear and will require further long-term study.
Trial registration: ClinicalTrials.govNCT00081328.
Keywords: adolescent; cardiac biomarkers; cardiovascular function; cardiovascular risk factors; type 2 diabetes.
Conflict of interest statement
The other authors declare no conflicts of interest.
Copyright © 2017 Elsevier Inc. All rights reserved.
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Source: PubMed