Exercise Training, Cardiac Biomarkers, and Cardiorespiratory Fitness in Type 2 Diabetes: The HART-D Study.

Background: High-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are cardiac biomarkers commonly detected in adults with type 2 diabetes (T2D) and are associated with heart failure risk.
Objectives: The purpose of this study was to evaluate the effects of exercise training (ET) on hs-cTnT and NT-proBNP and evaluate the associations of these biomarkers with cardiorespiratory fitness among adults with T2D.
Methods: Participants of the HART-D (Health Benefits of Aerobic and Resistance Training in Individuals with Type 2 Diabetes) trial who were randomly assigned to one of 3 ET groups or a non-exercise control group were included. Cardiac biomarkers and cardiorespiratory fitness (evaluated by peak oxygen uptake [VO _2peak ]) were assessed at baseline and after 9 months. The effects of ET (3 ET groups pooled) vs non-exercise control on hs-cTnT and NT-proBNP were assessed using separate analysis of covariance models. Multivariable-adjusted linear regression was performed to identify factors associated with follow-up biomarkers and ΔVO _2peak .
Results: The present study included 166 participants randomized to the ET (n = 135) and non-exercise control (n = 31) groups. Compared with the non-exercise control, ET did not significantly change hs-cTnT or NT-proBNP. In adjusted analysis, each ET group and ΔVO _2peak were not significantly associated with hs-cTnT or NT-proBNP levels on follow-up. Among individuals in the ET group, baseline hs-cTnT was inversely associated with ΔVO _2peak [per 1 SD higher log (hs-cTnT): β = -0.08 (95% CI = -0.15 to -0.01)].
Conclusions: Among individuals with T2D, ET did not modify cardiac biomarkers. Higher baseline hs-cTnT was associated with blunted cardiorespiratory fitness improvement in response to exercise.
Competing Interests: The HARTD Study was supported by grant DK-068298 from the National Institutes of Health. Funding for biomarker assays was provided by Roche Diagnostics. Dr Patel has served as a consultant to Novo Nordisk. Mr Ayers has received statistical consulting fees from the National Institutes of Health outside the submitted work. Dr Rohatgi is supported by NIH/NHLBI R01HL136724, NIH/NHLBI K24HL146838, and NHLBI R01HL146462. Disclosures include Merck research grant (significant), CSL Limited consultant (modest), HDL Diagnostics Advisory Board (modest). Dr Berry has received grant support from the NIH, Roche Diagnostics and Abbott Diagnostics; consulting fees from Roche Diagnostics, AstraZeneca, and the Cooper Institute. Dr deFilippi has received research grants from Roche Diagnostics; has received consulting fees from Abbott Diagnostics, FujiRebio, Metabolomics, Ortho Diagnostics, Roche Diagnostics, and Siemens Healthcare; has received honoraria from WebMD; and has received royalties from UpToDate. Dr Church serves as the Chief Medical Officer at Wondr Health, Dallas, TX, USA. Dr de Lemos has received grant support from Roche Diagnostics and Abbott Diagnostics; consulting fees from Roche Diagnostics, Abbott Diagnostics, Ortho Clinical Diagnostics, Quidel Cardiovascular, Inc, and Siemen’s Health Care Diagnostics; and has been named a co-owner on a patent awarded to the University of Maryland (US Patent Application Number: 15/309,754) entitled: “Methods for Assessing Differential Risk for Developing Heart Failure.” Dr Pandey has served on the advisory board of Roche Diagnostics; has received nonfinancial support from Pfizer and Merck; and has received research support from the Texas Health Resources Clinical Scholarship, the Gilead Sciences Research Scholar Program, the National Institute on Aging GEMSSTAR Grant (1R03AG067960-01), Myovista, and Applied Therapeutics.
(© 2023 The Authors.)