One-third of US adults with type 2 diabetes show evidence of asymptomatic CVD

Elizabeth Selvin, PhD, MPH

Credit: Johns Hopkins University

About 1 in 3 adults in the United States has Type 2 diabetes (T2D) There was asymptomatic evidence Cardiovascular disease (CVD) According to a new study, it is assessed by cardiac biomarkers.¹

This analysis suggests that asymptomatic CVD is strongly associated with increased risk of death in adult patients with T2D, even after adjusting for various demographic characteristics and cardiovascular risk factors, and further prevention efforts are warranted. emphasizes the need for

“What we are seeing is that many people with T2D who have no history of heart attack or CVD are at increased risk for cardiovascular complications,” said Professor of Epidemiology at the Johns Hopkins Bloomberg School of Public Studies. Dr. Elizabeth Selvin, MPH says. The Ministry of Health said in a statement:² “If you look at people diagnosed with T2D — about 27 million adults in the United States overall — some are at low risk of CVD, others are at high risk of CVD, according to the CDC. The question is, ‘Who has the most?’ Are they at risk? These cardiac biomarkers provide insight into cardiovascular risk in people who were otherwise not perceived to be at highest risk. “

The American Diabetes Association’s 2022 Consensus Report recommends drugs such as highly sensitive cardiac troponin (hs-cTn) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) to enable early detection and prevention of heart disease. Annual biomarker testing is recommended. Failure. Evidence to date suggests that elevation of both cardiac biomarkers may confer significant risk of major cardiac events and death in adults with diabetes. However, national data are lacking and little is known about the burden and long-term effects of asymptomatic CVD in adults with T2D in the general population.

The primary aim of the present analysis was to characterize the national prevalence of asymptomatic CVD as assessed by elevated hs-cTnT and NT-proBNP in US adults with and without diabetes. From 1999 he was enrolled in the 2004 National Health and Nutrition Examination Survey (NHANES). The analysis population included nonpregnant adults aged 20 years or older with no self-reported CVD and valid measurements of NT-proBNP, hs-cTnT, and covariates (n = 10,304).

Participants had no diabetes, newly diagnosed diabetes (within 1 year or self-reported no diagnosis of diabetes, HbA1c ≥ 6.5%), and short duration of diabetes (self-reported 1–10 years). diagnosed) and long-lived diabetes (≥6.5%). 10 years). The investigators defined asymptomatic CVD as elevated hs-cTnT (≥14 ng/L) or NT-proBNP (≥125 pg/mL) levels, measured using archived blood samples, and increased from baseline to 12 Mortality status was determined through association with the national mortality index by month. 2019.

Between 1999 and 2004, 7% of US adults without a history of CVD had diabetes, were generally older, and had a higher burden of cardiovascular risk factors. Analysis revealed that 33.4% of his T2D adults had signs of asymptomatic CVD, compared with only 16.1% of him in adults without diabetes. After adjusting for age, we observed that elevated hs-CTnT, but not elevated NT-proBNP, was more common in patients with diabetes overall and across age, sex, race, ethnicity, and weight status. it was done.

Furthermore, the prevalence of elevated hs-cTnT was significantly higher in individuals with longer duration of diabetes and worse glycemic control. In diabetic patients, elevated hs-cTnT and NT-proBNP were independently associated with all-cause mortality (adjusted hazard ratios) [aHR]1.77; [95% CI, 1.33 – 2.34] and HR, 1.78 [95% CI, 1.26 – 2.51), and CVD mortality (aHR, 1.54 [95% CI, 0.83 – 2.85] and aHR, 2.46 [95% CI, 1.31 – 4.60]).

Based on these findings, the investigative team emphasized that screening for specific cardiac biomarkers should be added to routine assessment of conventional cardiovascular risk factors.

“The biomarkers analyzed in this study are very powerful in systematically classifying patients based on their health status,” Selvin said.² “By measuring biomarkers more regularly, we may be able to focus on cardiovascular prophylaxis in high-risk T2D patients.”

References

1. Fang M, Wang D, Olive Tang et al. Asymptomatic cardiovascular disease in US adults with and without diabetes. Journal of the American Heart Association. Published online May 31, 2023. doi: https://doi.org/10.1161/JAHA.122.029083
2. heart news. One in three of her adults with type 2 diabetes may have undetected cardiovascular disease. Yulek Alert! May 31, 2023. Accessed May 31, 2023. https://www.eurekalert.org/news-releases/990479.