Multiple Biomarker Approach Predicts Increasing Risk Of Recurrent Cv Events In Patients With Diabetes Mellitus In The Examine Randomized Trial

Introduction: Patients with diabetes and recent acute coronary syndrome (ACS) have a significant but heterogeneous risk of recurrent cardiovascular (CV) events. Hypothesis: We hypothesized that a multimarker approach, utilizing biomarkers of stress, injury, or fibrosis, could stratify patients by risk for recurrent CV events, in particular CV death or heart failure (CVD/HF). Methods: The EXAMINE trial randomized 5380 patients with diabetes and ACS within the prior 15-90 days to alogliptin or placebo. Biomarkers were measured at baseline and were classified as elevated as follows: hs-TnI (≥26 ng/L), BNP (≥80 pg/ml), ST2 (≥35 ng/ml), GDF-15 (u003e1800 pg/ml), and FGF-23, adiponectin and galectin-3 (4th quartile). Two year KM rates of CVD/HF were evaluated by total risk, defined by the arithmetic sum of the number of elevated biomarkers. Results: 5162 patients (96%) had values for all biomarkers with a 2y rate of CV death or HF of 7%. Each biomarker was an independent predictor of CVD/HF beyond the clinical char...