Type 2 diabetes patients may be at a higher risk for heart disease without knowing it, according to a new study. The research indicates that 33% of people with diabetes had higher levels of two biomarkers in their blood linked to heart disease. These biomarkers, known as high-sensitivity cardiac troponin (hs-troponin) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), can be detected before someone has heart disease symptoms, allowing for earlier screening and, consequently, more effective prevention efforts or treatment.
Elizabeth Selvin, PhD, MPH, a professor of epidemiology at Johns Hopkins Bloomberg School of Public Health in Baltimore and senior study author, noted that “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 the future occurrence of cardiovascular events.”
Historically, the finger of blame for higher heart disease risk in people with type 2 diabetes was pointed at bad cholesterol. However, this study suggests that other factors are at play and that treatments beyond ones that lower cholesterol should now be considered. Selvin suggested that hypertension treatment and interventions that target microvascular or small vessel health could be particularly beneficial in people with diabetes.
The research team identified two biomarkers – hs-troponin and NT-proBNP – that have previously been studied in middle-aged and older white adults. The burning questions for researchers was whether these biomarkers could be used to identify those at higher risk before symptoms start, especially among a more diverse group of people nationwide.
The test used stored blood samples from a large, nationally representative group of 10,304 adults aged 20 years or over. Those who participated in the study reported no heart disease when they entered the National Health and Nutrition Examination Survey (NHANES) project between 1999 and 2004. By going back to stored blood samples from about two decades ago, Selvin and her colleagues were able to track deaths from heart disease or any cause up until the end of 2019.
The data showed 33% of people with type 2 diabetes had higher blood levels of one or the other biomarker, compared to only 16% of people without diabetes. The research team found that hs-troponin indicates damage to the heart, while NT-proBNP suggests pressure is building up in the heart wall enough to stress or stretch it. The fact that people with diabetes and either one or both biomarkers were more likely to die from diabetes or any cause should facilitate earlier screening to prompt effective interventions.
The study also found that the risk of heart disease was highest among those who had diabetes longer and those whose blood sugar was less well-controlled. After researchers controlled for other cardiovascular risk factors, the higher risk remained. The risk of death was higher among those aged 45 to 64, as opposed to those aged 65 and over.
The biomarker results could be used to determine which patients could most benefit from treatments with a sodium-glucose cotransporter-2 (SLGT2) inhibitor such as canagliflozin, dapagliflozin and empagliflozin, or a glucagon-like peptide-1 (GLP-1) receptor agonist, such as semaglutide and liraglutide. Selvin believes more research is needed to understand the best way to use cardiac biomarkers in routine practice to improve the lives of high-risk people with diabetes and other individuals at high risk for cardiovascular disease. She believes intervention studies and clinical trials could be particularly helpful in this area.
Vijay Nambi, MD, a cardiologist with Baylor College of Medicine in Houston, thinks that these biomarkers have consistently shown that they are able to identify higher-risk individuals, and he recommends that they should be used more routinely. Using biomarker results to tailor management to an individual “would be even more powerful and impactful,” Nambi suggested.
Cardiovascular disease is linked to 40% of hospitalizations and 30% of deaths among people with type 2 diabetes, according to the study. An estimated 27 million American adults have type 2 diabetes. The research team’s findings are published in the Journal of the American Heart Association.