Prognostic Value of High-Sensitivity Troponin in Predicting Long-Term Cardiovascular Outcomes in Patients With Type 2 Diabetes: A Systematic Review.

Cardiovascular disease remains the leading cause of morbidity and mortality among patients with type 2 diabetes mellitus (T2DM). While conventional risk assessment tools often lack precision in diabetic populations, high-sensitivity cardiac troponins (hs-cTn), particularly high-sensitivity troponin T (hs-TnT) and high-sensitivity troponin T I (hs-TnI), have emerged as promising biomarkers capable of detecting subclinical myocardial injury and predicting adverse cardiovascular outcomes. This systematic review aimed to evaluate the prognostic effectiveness of hs-cTn in predicting long-term cardiovascular events in individuals with T2DM. A comprehensive search of PubMed, Scopus, and Web of Science was conducted for studies published up to March 2025, limited to English-language human studies. Only four studies met the inclusion criteria, reflecting the limited but focused evidence base. These studies varied in population characteristics, ranging from stable outpatients to patients with diabetic nephropathy and post-acute coronary syndrome, and in the outcomes assessed, including cardiovascular and all-cause mortality, heart failure, and renal events. Given this heterogeneity in both populations and endpoints, a narrative synthesis approach was adopted. Despite differences, elevated hs-cTn levels were consistently associated with worse long-term outcomes, although the strength of associations varied, with more consistent predictive value observed for cardiovascular and all-cause mortality compared to renal events. While findings support the potential of hs-cTn as a risk stratification tool in T2DM, the small number of eligible studies and variability in study designs limit generalizability and highlight the need for further research.