Adding multiproteomic biomarkers to a clinical risk model for the evaluation of patients with diabetes and a recent myocardial infarction may provide better risk assessment and targeted treatment decisions, according to a study published in Clinical Research in Cardiology.

In this study, data from the Examination of Cardiovascular Outcomes with Alogliptin versus Standard of Care trial ( Identifier: NCT00968708) were analyzed. Investigators sought to determine whether a multi-proteomic approach (including 93 circulating proteins, with 92 proteins from the Olink CVDII panel plus troponin) would provide different proteomic signatures for specific cardiovascular outcomes and improve the discrimination between these outcomes.

All participants were diagnosed with type 2 diabetes mellitus, were receiving antidiabetic therapy (other than a DPP-4 inhibitor or GLP-1 analog), and had had an acute coronary syndrome within 15 to 90 days of randomization.

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A total of 5131 patients were included (mean age, 61±10 years; 68% men). The study’s primary outcome, a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke, occurred in 11.5% of patients. A composite of cardiovascular death or hospitalization for heart failure occurred in 7.3% of participants, and all-cause death, cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and hospitalization for heart failure hospitalization occurred in 5.9%, 4.4%, 6.7%, 1.2, and 3.6% of patients, respectively.

Troponin and brain natriuretic peptide (BNP) were found to provide added prognostic information for a composite of cardiovascular death, myocardial infarction, or stroke (∆C-index + 5%) and cardiovascular death alone (∆C-index + 7%), when used in conjunction with a clinical model that included age, sex, smoking, duration of diabetes, history of myocardial infarction, history of hospitalization for heart failure, history of stroke, atrial fibrillation, hypertension, systolic blood pressure, statin therapy, estimated glomerular filtration rate, and study treatment (ie, alogliptin or placebo).

The incorporation of troponin, BNP, and trail receptor 2 added prognostic information regarding all-cause death and the composite of cardiovascular death or hospitalization for heart failure, and the addition of BNP and Gal-9 improved the prognosis for heart failure hospitalization alone. Troponin, fibroblast growth factor 23, and α-1-microglobulin/bikunin precursor added prognostic value for myocardial infarction, and only troponin added prognostic value for stroke.

Study limitations include the fact that it was a post hoc analysis of a prospective randomized trial.

“The addition of multi-proteomic biomarkers to a clinical model in this population with diabetes and a recent [myocardial infarction] showed that ischemia and myocardial stretch are major outcome drivers in this population, and allowed a better risk prediction and event reclassification, potentially helping for better risk assessment and targeted treatment decisions,” the researchers commented.

Disclosures: Some of the authors declared affiliations with the pharmaceutical industry. Please see the original reference for a complete list of disclosures.


Ferreira JP, Sharma A, Mehta C, et al. Multi‑proteomic approach to predict specific cardiovascular events in patients with diabetes and myocardial infarction: findings from the EXAMINE trial [published online August 13, 2020]. Clin Res Cardiol. doi:10.1007/s00392-020-01729-3