Study Finds One in Three Type 2 Diabetics May Have Undiagnosed Heart Disease, a Hidden Risk
According to a study from the Johns Hopkins Bloomberg School of Public Health, one-third of persons with Type 2 diabetes may inadvertently have cardiovascular disease, as shown by two increased protein biomarkers. According to the research, frequent testing for these biomarkers, which are often used to diagnose heart conditions, could assist identify patients who are more likely to develop cardiovascular disease and, as a result, influence preventative therapy for people with Type 2 diabetes.
According to a recent study appearing in the Journal of the American Heart Association, two biomarkers linked to heart disease are present in higher levels in one-third of persons with Type 2 diabetes.
In a new study, compared to non-diabetic adults, adults with Type 2 diabetes had higher levels of two protein biomarkers indicative of cardiac injury. This finding was just reported in the Journal of the American cardiac Association.
Heart damage and stress can be detected with tests that evaluate the concentration of high-sensitivity cardiac troponin T and N-terminal pro-B-type natriuretic peptide biomarkers, which are also used to diagnose heart attacks and heart failure.
"What we are seeing is that many people with Type 2 diabetes who have not had a heart attack or a history of cardiovascular disease are at high risk for cardiovascular complications," said study co-author and professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Elizabeth Selvin, Ph.D., M.P.H. The open question is, "Who is most at risk?" Of the approximately 27 million adults in the U.S. who have been diagnosed with Type 2 diabetes, some have low risk and some have high risk for cardiovascular disease.These cardiac biomarkers provide us with a window into cardiovascular risk in individuals who might not otherwise be identified as being at the highest risk.
More than 10,300 persons' health records and blood samples were examined by researchers as part of the 1999–2004 National Health and Nutrition Examination Survey. The study's objective was to ascertain if higher levels of cardiac protein biomarkers in individuals with and without Type 2 diabetes may be used to identify previously undiagnosed cardiovascular disease without symptoms. When they signed up for the trial, participants said they had no prior history of cardiovascular illness.
Two cardiac biomarkers were assessed in banked blood samples from each study participant. Data on mortality was gathered from the National Death Index. They evaluated the relationships between high troponin and N-terminal pro-B-type natriuretic peptide levels and risk of death from cardiovascular reasons or from all causes after controlling for age, race, income, and cardiovascular risk factors.
The study revealed:
- Elevated levels of the two protein markers suggested undiagnosed cardiovascular disease in 33.4% of persons with Type 2 diabetes, compared to only 16.1% of those without the condition.
- In comparison to normal levels of these proteins in the blood, adults with Type 2 diabetes who had elevated levels of troponin and N-terminal pro-B-type natriuretic peptide had an increased risk of dying from all causes (77% and 78%, respectively) and dying from cardiovascular causes (54% and more than double the increased risk, respectively). Even after accounting for additional cardiovascular risk factors, this higher risk persisted.
- Elevated troponin levels were more prevalent in patients with Type 2 diabetes overall and across categories of age, sex, race/ethnicity, and weight after age was taken into account. In contrast, after adjusting for age, levels of N-terminal pro-B-type natriuretic peptide were not higher in those with Type 2 diabetes than in those without it.
- People with Type 2 diabetes who had it for a longer time and had poorly regulated blood sugar levels were far more likely to have elevated troponin levels.
"We frequently focus on lowering cholesterol to lower the risk of cardiovascular disease in Type 2 diabetics. But Type 2 diabetes may directly affect the heart without affecting cholesterol levels. Cholesterol-lowering drugs won't stop cardiac damage if Type 2 diabetes is directly damaging the heart's tiny blood arteries without any involvement from cholesterol plaque development, Selvin added. According to our research, additional non-statin medications are required to reduce the risk of cardiovascular disease in Type 2 diabetics.
The impact of conventional risk factors on cardiovascular health, such as high blood pressure and cholesterol, has been the subject of much research. However, recent data point to the need for routine cardiac biomarker screening in addition to the assessment of conventional risk factors.
The biomarkers examined in this study are quite effective at systematically classifying patients according to their state of health. We may be able to concentrate on cardiovascular prevention medications for Type 2 diabetes patients who are at higher risk if we measure biomarkers more frequently, she noted.
One of the first studies to use subjects that accurately represent the broader community is this one. More research is required to ascertain whether regular measurement of these biomarkers may lessen cardiovascular complications in this population because the data did not allow the identification of heart disease, heart failure, stroke occurrences, or cardiovascular complications.
Reference:
"Subclinical Cardiovascular Disease in US Adults With and Without Diabetes" by Michael Fang, Dan Wang, Olive Tang, John William McEvoy, Justin B. Echouffo-Tcheugui, Robert H. Christenson, and Elizabeth Selvin, published in the American Heart Association Journal on May 31, 2023.
The Foundation for the National Institutes of Health's Biomarkers Consortium provided funding for the study.
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