1 in 3 Type 2 Diabetics May Have Undetected Heart Disease
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1 in 3 Type 2 Diabetics May Have Undetected Heart Disease, Study Reveals.
A new study recently published in the Journal of the American Heart Association found an association between elevated levels of two protein biomarkers that indicate heart damage and undetected or asymptomatic cardiovascular disease in adults with type 2 diabetes compared with non-diabetic adults.
Tests that measure concentrations of high-sensitivity cardiac troponin T and N-terminal pro-B-type natriuretic peptide biomarkers are commonly used to detect damage and stress to the heart and are standard methods for diagnosing heart attack and heart failure.
However, even slightly elevated levels of these proteins in the blood can be a potential early indicator of changes in heart structure and function, potentially increasing the risk of heart failure, coronary heart disease or death in the future.
“We’re seeing that many people with type 2 diabetes who don’t have a history of heart attack or cardiovascular disease are at high risk for cardiovascular complications,” said study co-author Elizabeth Selvin, MD, professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health in Baltimore. “According to the CDC, about 27 million adults in the United States have been diagnosed with type 2 diabetes, and when we look at the population as a whole, some are at low risk for cardiovascular disease and some are at high risk. And the open question is: ‘Who is most at risk?’ These cardiac biomarkers give us a window into cardiovascular risk in people who might not otherwise be identified as high risk.”
The researchers analyzed health information and blood samples from more than 10,300 adults as part of the US National Health and Nutrition Examination Survey from 1999 to 2004.
The aim of the study was to determine whether previously undetected asymptomatic cardiovascular disease could be identified by elevated levels of cardiac protein biomarkers in patients with and without type 2 diabetes.
Study participants reported no history of cardiovascular disease at the time of study participation.
Using stored blood samples from all study participants, the researchers measured levels of two cardiac biomarkers. The researchers collected mortality statistics from the National Death Index.
They assessed the association between elevated troponin and N-terminal pro-B-type natriuretic peptide and the risk of cardiovascular or all-cause death after adjusting for age, race, income, and cardiovascular risk factors.
Statistics found that one-third (33.4%) of adults with type 2 diabetes had undetected signs of cardiovascular disease, manifested by elevated levels of these two protein markers, compared with 16.1% of adults without diabetes.
In adults with type 2 diabetes, elevated levels of troponin and N-terminal pro-B-type natriuretic peptide were associated with increased risk of all-cause mortality (77% and 78%, respectively) and cardiovascular death (54% and more than twofold, respectively), despite normal blood levels of these two proteins.
This elevated risk persisted after adjustment for other cardiovascular risk factors.
After adjusting for age, elevated troponin levels were more common in people with type 2 diabetes and across age, sex, race/ethnicity, and weight groups.
In contrast, N-terminal pro-B-type natriuretic peptide levels were not elevated in type 2 diabetic patients compared with non-type 2 diabetic patients after adjustment for age.
The incidence of elevated troponin was significantly higher in people with longer duration of type 2 diabetes and poor glycemic control.
“Cholesterol is often the factor we target to reduce the risk of cardiovascular disease in type 2 diabetes. However, the direct effects of type 2 diabetes on the heart may not be related to cholesterol levels,” Selvin said. “If type 2 diabetes directly causes damage to small blood vessels in the heart and is not related to cholesterol plaque buildup, then cholesterol-lowering drugs cannot prevent heart damage. Our study shows that additional non-statin-related therapies are needed to reduce the risk of cardiovascular disease in type 2 diabetes.”
Much research has focused on how traditional risk factors such as hypertension and cholesterol affect cardiovascular health, however, emerging evidence suggests that screening for certain cardiac biomarkers should be added to routine assessment of traditional cardiovascular risk factors.
The biomarkers analyzed in this study are so powerful that they can be systematically categorized according to the health status of patients.
More routine measurement of biomarkers may help us focus our efforts on providing cardiovascular preventive therapies to patients with type 2 diabetes.
1 in 3 Type 2 Diabetics May Have Undetected Heart Disease
(source:internet, reference only)
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