Conclusions
The current study demonstrates that in patients with type 2 diabetes, higher levels of NT-proBNP and hsTnT are associated with an increased risk of developing microvascular complications, particularly nephropathy. This association was attenuated after accounting for conventional risk factors for, and mediators of, macrovascular complications; the relationship between NT-proBNP and hsTnT and established CV risk factors may, at least in part, explain their prognostic value. Models designed to simulate a clinical score for the prediction of microvascular events showed an ability to discriminate between patients who will and will not develop microvascular complications. We suggest that subclinical cardiac disease might be an antecedent of peripheral microvascular disease. Thus, an approach that combines clinical predictors with biomarkers such as NT-proBNP and hsTnT may help to identify patients with type 2 diabetes who are at greatest risk of microvascular complications (particularly nephropathy) and may benefit most from strategies to reduce this risk. However, our data also illustrate that prediction of nephropathy and retinopathy are dependent on different risk factors, reflecting distinct mechanistic pathways. As such, specific prediction of retinopathy (without retinal scanning data) remains challenging using conventional risk factors and cardiac biomarkers.