In the Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes (BARI 2D) study, Everett et al. (Aug. 13 issue)1 report that an abnormal level of cardiac troponin T was an independent predictor of cardiovascular events in elderly patients with type 2 diabetes and stable ischemic heart disease. They also report that an abnormal troponin T value (≥14 ng per liter) did not identify patients who might have benefited from prompt coronary revascularization. Several lines of evidence now show that the troponin T level is markedly influenced by aging, owing to decreased renal function, coexisting medical conditions, and increased turnover of myocardiocytes among elderly patients.2 More specifically, the 99th percentile of the troponin T level was found to be 16 ng per liter among patients between the ages of 50 and 75 years, whereas a considerably higher 99th percentile (71 ng per liter) was observed among those 75 years of age or older.3 Therefore, the use of age-specific cutoffs rather than a fixed threshold would have been more appropriate for establishing cardiovascular outcomes among elderly patients with type 2 diabetes.
Troponin in Stable Ischemic Heart Disease and Diabetes
LIPPI, Giuseppe;TARGHER, Giovanni;
2015-01-01
Abstract
In the Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes (BARI 2D) study, Everett et al. (Aug. 13 issue)1 report that an abnormal level of cardiac troponin T was an independent predictor of cardiovascular events in elderly patients with type 2 diabetes and stable ischemic heart disease. They also report that an abnormal troponin T value (≥14 ng per liter) did not identify patients who might have benefited from prompt coronary revascularization. Several lines of evidence now show that the troponin T level is markedly influenced by aging, owing to decreased renal function, coexisting medical conditions, and increased turnover of myocardiocytes among elderly patients.2 More specifically, the 99th percentile of the troponin T level was found to be 16 ng per liter among patients between the ages of 50 and 75 years, whereas a considerably higher 99th percentile (71 ng per liter) was observed among those 75 years of age or older.3 Therefore, the use of age-specific cutoffs rather than a fixed threshold would have been more appropriate for establishing cardiovascular outcomes among elderly patients with type 2 diabetes.
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