Background Persons with pre-diabetes and diabetes are at high risk for cardiovascular events. However, the relationships of pre-diabetes and diabetes to development of subclinical myocardial damage are unclear. Methods and Results We measured cardiac troponin T with a highly sensitive assay (hs-cTnT) at two time points, 6 years apart, among 9,331 participants of the community-based Atherosclerosis Risk in Communities (ARIC) Study with no diabetes, pre-diabetes, or diabetes but without cardiovascular disease including silent MI by ECG. First, we examined incidence of elevated hs-cTnT (≥14 ng/L) at 6 years of follow-up. Second, we examined clinical outcomes during the subsequent ~14 years of follow-up among persons with and without incident elevated hs-cTnT. Cumulative probabilities of elevated hs-cTnT at 6 years among persons with no diabetes, pre-diabetes, and diabetes were 3.7%, 6.4%, and 10.8%, respectively. Compared to normoglycemic persons, the adjusted relative risks for incident elevated hs-cTnT were 1.38 (95%CI 1.07-1.77) for pre-diabetes and 2.46 (95%CI 1.77-3.42) for diabetes. Persons with diabetes and incident elevations in hs-cTnT were at a substantially higher risk of heart failure (HR 6.37, 95%CI 4.27-9.51), death (HR 4.36, 95%CI 3.14-6.07) and coronary heart disease (HR 3.84, 95%CI 2.52-5.84) compared to persons without diabetes and no incident elevation in hscTnT. Conclusions Pre-diabetes and diabetes were independently associated with development of subclinical myocardial damage, as assessed by hs-cTnT, and those persons with evidence of subclinical damage were at highest risk for clinical events. These results support a possible deleterious effect of hyperglycemia on the myocardium, possibly reflecting a microvascular etiology.

BackgroundAlthough weight loss is common in nasopharyngeal carcinoma (NPC) patients receiving radiotherapy, the prognostic influence of weight loss and its impact modified by body mass index (BMI) are still unclear.Methods2433 NPC patients receiving radical radiotherapy at Sun Yat-sen University Cancer Center from November, 2000 to December, 2004 were enrolled. Weight change during radiation treatment was categorized into high weight loss (HWL) and low weight loss (LWL). The associations of HWL with overall survival (OS) and disease-specific survival (DSS) were analyzed by Cox regression.ResultsAmong underweight patients, HWL was independently associated with poor OS (hazard ratio [HR], 2.06; 95% CI 1.36–3.11) and DSS (HR, 2.27; 95% CI 1.38–3.73), as compared with LWL, after adjusting for covariates. In normal weight patients, the impact of HWL on OS (HR, 1.47; 95% CI 1.19–1.80) and DSS (HR, 1.59; 95% CI 1.24–2.03) was moderate. Among overweight/obese patients, no significant association between HWL and OS (HR, 1.22; 95% CI 0.95–1.55), or DSS (HR, 1.23; 95% CI 0.93–1.64) was found.ConclusionExcept for overweight/obese patients, high weight loss during radiation treatment was independently associated with poor survival in NPC. This impact was more prominent in the underweight patient group.