Evaluation of biochemical evidence suggestive of subclinical myocardial injury using high-sensitivity cardiac troponin T in patients with prediabetes: a cross-sectional study.

Abstract

Background: Growing evidence indicates that cardiovascular abnormalities may develop during the prediabetic period. One of the earliest signs of these is biochemical evidence suggestive of subclinical myocardial injury characterised by elevated high-sensitivity cardiac troponin levels (>the 99th percentile upper reference limit). There is a paucity of studies on high-sensitivity troponin T (hs-cTnT) levels, the prevalence of subclinical myocardial injury, and related cardiometabolic predictors in individuals with prediabetes in Southeast Asia. Therefore, this study aimed to determine the distribution of hs-cTnT values suggestive of subclinical myocardial injury; assess the relationship between hs-cTnT values and HbA1c levels; and identify the predictors of suggestive of subclinical myocardial injury in people with prediabetes in Kota Bharu, Kelantan, Malaysia.

Methods: This cross-sectional study included 101 adults with prediabetes at two primary care centres in Kota Bharu, Kelantan, Malaysia. Blood samples were collected for the evaluation of hs-cTnT, HbA1c, lipid profile (total cholesterol, triglycerides, high- and low-density lipoprotein cholesterol), urea, and creatinine levels. Biochemical evidence suggestive of subclinical myocardial injury was defined as hs-cTnT concentrations >14.00 ng/L. Associations between hs-cTnT values and HbA1c levels were analysed using Spearman's rank correlation; predictors suggestive of subclinical myocardial injury were evaluated using Firth bias-corrected logistic regression.

Results: The median hs-cTnT value was 7.29 ng/L (interquartile range: 3.85-12.33). Biochemical evidence suggestive of subclinical myocardial injury was detected in 14.9% (n = 15) of participants. Hs-cTnT values in participants suggestive of myocardial injury ranged from 14.71 to 149.20 ng/L. No significant association was found between hs-cTnT values and HbA1c levels (Spearman's r = -0.053; p = 0.602). In exploratory Firth bias-corrected multivariable logistic regression analysis, higher systolic blood pressure was independently associated with biochemical evidence suggestive of subclinical myocardial injury after adjusting for demographic, metabolic, and cardiovascular risk factors (adjusted odds ratio: 1.13per mmHg increase, 95% confidence interval: 1.05-1.24; p = 0.001).

Conclusions: Biochemical evidence suggestive of subclinical myocardial injury was present in 14.9% of adults with prediabetes, possibly associated with elevated systolic blood pressure. No significant association was found between hs-cTnT values and HbA1c levels. These findings suggest that myocardial injury may occur early during prediabetes. A larger population-based study would help verify these findings and determine the clinical significance of subclinical myocardial injury in this patient population.