May 31, 2023 – If you have got type 2 diabetes, it’s possible you’ll already be at higher risk for heart disease without knowing it. About a 3rd of diabetics in a recent study had elevated levels of two substances of their blood which can be linked to heart disease.
These blood “biomarkers” could be detected before someone shows symptoms of heart disease, so that they may very well be used to screen people for higher risk earlier, when preventive measures or treatments could also be simpler, the researchers said.
“People with diabetes should be aware that they are at high cardiovascular risk and should work with their doctors to develop a treatment plan that can prevent future cardiovascular events,” said lead study writer Elizabeth Selvin, PhD, MPH, professor of epidemiology on the Johns Hopkins Bloomberg School of Public Health in Baltimore.
Until now, bad cholesterol has been blamed for a better risk of heart disease in individuals with type 2 diabetes. This study suggests there’s something else occurring and that other treatments – besides people who lower cholesterol – ought to be considered.
“Our findings suggest that treating hypertension and interventions targeting microvascular, or small vessel, health may be particularly helpful in people with diabetes,” Selvin said.
Heart under stress
Selvin, lead researcher Michael Fang, PhD, MHS, and their colleagues tested for 2 specific biomarkers. They found that 33% of individuals with type 2 diabetes had elevated blood levels of 1 biomarker or the opposite, compared with only 16% of individuals without diabetes.
The study was published online today in Journal of the American Heart Association.
One biomarker protein, high-sensitivity cardiac troponin (hs-troponin), indicates damage to the center. The other, N-terminal pro-B-type natriuretic peptide (NT-proBNP), indicates that a lot pressure is build up in the center that the center wall is strained or stretched.
Cardiovascular disease accounts for 40% of hospitalizations and 30% of deaths in individuals with type 2 diabetes, so it's vital to discover those in danger before symptoms appear. An estimated 27 million adults within the United States have type 2 diabetes.
Large, diverse population
These two biomarkers have been studied previously, but primarily in middle-aged and older white adults.
They're primarily done in hospitals to check individuals with chest pain and/or shortness of breath. They're not generally used to detect heart disease – but recent data like this study suggests they might play a task in prevention or risk prediction, said Dr. Vijay Nambi, a cardiologist at Baylor College of Medicine in Houston.
This current study tested blood samples from a more diverse, nationally representative group of 10,304 adults ages 20 and older. For example, 60% of those with type 2 diabetes were non-Hispanic, 15% were non-Hispanic, 9% were Mexican, and 16% were of one other race or ethnicity.
Study participants reported no heart disease after they participated within the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2004. By using stored blood samples from about 20 years ago, Selvin and his colleagues were in a position to track deaths from heart disease or other causes within the National Death Index through the tip of 2019.
Key findings
A bigger proportion of individuals with diabetes had higher hs-troponin levels – 19% in comparison with 5% of individuals without diabetes. More muscle disease and frailty in individuals with diabetes may explain this difference, the researchers noted.
The researchers also found that the danger of heart disease was highest in individuals who had an extended history of diabetes and had poorer blood sugar control.
The other biomarker, NT-proBNP, was not significantly higher within the diabetes group. But diabetics with one or each biomarkers had a better risk of dying from diabetes or from some other cause. For example, in adults with type 2 diabetes, the danger of cardiovascular death was 54% higher with elevated hs-troponin and a pair of.5 times higher with elevated blood NT-proBNP levels. The risk of dying from any cause was 77% higher with hs-troponin and 78% higher with NT-proBNP on this population.
The higher risk endured even after researchers took other cardiovascular risk aspects under consideration.
The risk of death was also higher amongst those aged 45 to 64 than amongst those over 65.
“These strategies need to be formally tested, but these biomarkers have consistently shown their ability to identify people at higher risk. So overall, we should seriously consider using these biomarkers routinely,” Nambi said.
Screening for heart risk
Selvin and his colleagues not only identified the aspects that cause the upper risk, but additionally made suggestions about what may very well be done about it.
“Our findings support the potential use of these cardiac biomarkers for routine risk monitoring, particularly in high-risk populations where we may be able to use them to tailor cardiovascular therapy,” Selvin said.
Using biomarker results to tailor treatment to the person “would be even more powerful and effective,” Nambi agreed.
Taking a blood sample from individuals with type 2 diabetes to check these two things could help prioritize who gets treated with a sodium-glucose cotransporter 2 (SLGT2) inhibitor, Selvin said. Drugs within the SLGT2 class include canagliflozin, dapagliflozin and empagliflozin. The results could also guide treatment with a glucagon-like peptide-1 (GLP-1) receptor agonist. GLP-1 drugs like semaglutide (Ozempic) and liraglutide (Victoza 3-Pak) have received a whole lot of attention recently due to their weight reduction potential.
More research is required, Selvin said.
“We need to understand how best to use cardiac biomarkers in routine practice to improve the lives of people with diabetes and others at high risk for cardiovascular disease,” she said. “Intervention studies and clinical trials could be particularly helpful in developing best practices in this area.”