Make Way for Biomarkers: Predicting Heart Disease in Type 2 Diabetes
A new analysis has identified biomarkers that significantly improve predicting cardiovascular risk in people with type 2 diabetes. Could these biomarkers change how people with diabetes are screened for heart disease?
While there have been dramatic advancements in the management of cardiovascular disease (CVD) among people with diabetes – especially with the development of drugs, such as SGLT-2s and GLP-1s – predicting who will develop the condition remains challenging.
It’s widely known that people with type 2 diabetes are twice as likely to have CVD compared to people without diabetes. But how can healthcare providers identify people who are at the highest risk for heart disease?
Previously, risk scores were used to estimate an individual’s risk of developing heart disease. These simple questionnaires asked about factors like age, gender, family history, and high blood pressure to determine a person’s risk of heart disease.
However, calculators that use these traditional CVD risk factors aren’t as helpful in diverse populations and among people who have already had a heart attack, stroke, or chronic heart failure.
A new analysis has identified 13 biomarkers that significantly improve the prediction of cardiovascular risk in people with type 2 diabetes. Biomarkers are molecules in the body that indicate normal or abnormal processes, such as the healthy functioning of an organ or the presence of disease.
What were key findings from the study?
Experts from Johns Hopkins University, Lund University in Sweden, and the Chinese University of Hong Kong examined the differences between people with type 2 diabetes who developed CVD compared to those who did not.
In total, the researchers analyzed 195 biomarkers across over 400 published studies from 1990 onwards. Overall, the biomarker NT-proBNP had the highest predictive value and consistency across studies. Higher levels of NT-proBNP were linked to a greater risk of CVD.
Other promising biomarkers for cardiovascular disease included troponin-T (TnT) and coronary computed tomography angiography (CCTA). TnT is a protein found in the heart muscle; it circulates in the blood when the heart muscle is damaged, usually due to a heart attack. CCTA is an imaging biomarker test that reveals plaque and blockages in the arteries that supply the heart with blood.
What is NT-proBNP?
It sounds like something out of a science fiction movie, but N-terminal pro b-type natriuretic peptide (NT-proBNP) is a protein made by the heart and blood vessels.
When the heart has to work harder than usual to pump blood, high levels of NT-proBNP are produced. NT-proBNP is an ingredient for making another protein called brain natriuretic peptide (BNP), which helps lessen the heart’s workload by lowering blood pressure. Together, NT-proBNP and BNP are primary heart failure biomarkers.
NT-proBNP is already widely used to monitor heart failure, which occurs when the heart has a hard time pumping enough oxygenated blood for the body’s daily needs. Researchers also noted that NT-proBNP may be useful for predicting heart disease in the general population.
The bottom line
According to the researchers, this analysis is one of the most comprehensive reviews of estimating heart disease risk in people with type 2 diabetes.
By focusing on predictors of “hard” outcomes – like heart attacks and strokes – researchers were able to find biomarkers that could be used to identify people at the highest risk of cardiovascular events in clinical practice.
Future analyses may be able to identify predictors of early heart disease, which could lead to better prevention of CVD. Ultimately, early intervention along with blood sugar management could lead to better outcomes for people with type 2 diabetes.
One of the major limitations of this investigation was that the majority of participants in the studies examined were European, so the results may not apply to other populations.
Overall, these findings have the potential to transform the future of medical care for people with type 2 diabetes. In particular, the discovery and validation of biomarkers may enable precision medicine – that is, personalized treatment based on an individual’s unique characteristics, biomarkers, and risks for different complications.
Learn more about managing cardiovascular disease with diabetes here: