One in three adults with Type 2 diabetes have elevated levels of biomarkers of cardiovascular disease, even if they do not have symptoms, new research says. This work supports the idea that screening for cardiac biomarkers should be added to routine cardiovascular risk assessment. It also suggests new types of treatment may be needed.
In this study, blood sample analysis from more than 10,300 adults looked at high-sensitivity cardiac troponin T and N-terminal pro-B-type natriuretic peptide—biomarkers routinely used to diagnose heart attack and heart failure. More than 33% of the patients with Type 2 diabetes had elevated levels of these markers. That was twice the rate seen among adults without diabetes.
The research appears today in the Journal of the American Heart Association.
“These cardiac biomarkers give us a window into cardiovascular risk in people who otherwise might not be recognized as highest risk,” said study co-author Elizabeth Selvin, PhD, a professor of epidemiology at Johns Hopkins Bloomberg School of Public Health in Baltimore.
According to the American Heart Association’s 2023 Statistical Update, 102,188 U.S. deaths in 2020 were attributed to diabetes (including Type 1 and Type 2 diabetes) and an estimated 1.64 million deaths globally. The CDC estimates that about 27 million adults in the U.S. alone have Type 2 diabetes. All of these patients are at elevated risk of cardiovascular disease. The question is, Slevin said, “Who is at highest risk?”
Even mildly elevated blood concentrations of the two proteins measured in this study can be an early warning sign of changes in the structure and function of the heart.
The health data and blood samples were collected as part of the U.S. National Health and Nutrition Examination Survey from 1999 to 2004. Study participants had reported no history of cardiovascular disease when they enrolled. Mortality statistics were collected from the National Death Index. After adjusting for age, race, income and cardiovascular risk factors, the researchers assessed the associations among elevated troponin and N-terminal pro-B-type natriuretic peptide with risk of death from cardiovascular death or all causes.
The study’s findings included:
- One-third (33.4%) of adults with Type 2 diabetes had signs of undetected cardiovascular disease, as indicated by elevated levels of the two protein markers, compared to only 16.1% of those without diabetes.
- Among the adults with Type 2 diabetes, elevated levels of troponin and Nterminal pro-B-type natriuretic peptide were associated with an increased risk of all-cause death (77% and 78% increased risk, respectively) and cardiovascular death (54% and more than double the increased risk, respectively).
- The prevalence of elevated troponin was significantly higher in people who had Type 2 diabetes for a longer period of time and who did not have well-controlled blood sugar levels.
“Cholesterol is often the factor that we target to reduce the risk of cardiovascular disease in people with Type 2 diabetes. However, Type 2 diabetes may have a direct effect on the heart not related to cholesterol levels. If Type 2 diabetes is directly causing damage to the small vessels in the heart unrelated to cholesterol plaque buildup, then cholesterol-lowering medications are not going to prevent cardiac damage,” Selvin said. “Our research suggests that additional non-statin-related therapies are needed to lower the cardiovascular disease risk in people with Type 2 diabetes.”
“The biomarkers analyzed in this study are very powerful in systematically categorizing patients based on their health status. Measuring biomarkers more routinely may help us focus on cardiovascular prevention therapies for people with Type 2 diabetes who are at higher risk,” she added.
