1 in 3 adults with type 2 diabetes may have undetected cardiovascular disease

Research highlights:

• One-third of adults with type 2 diabetes in the United States may have asymptomatic or undetected cardiovascular disease.
• Adults with type 2 diabetes who have no signs or symptoms of cardiovascular disease are more likely than adults without type 2 diabetes to have elevated levels of two proteins associated with heart disease. These cardiac biomarkers are associated with an increased risk of cardiovascular disease and all-cause mortality.
• The results of this study suggest that routine screening for these two cardiac biomarkers and more customized interventions may help reduce the risk of cardiovascular disease events in this high-risk population. I’m here.

Embargoed until Wednesday, May 31, 2023, 4:00 am Central Time / 5:00 am Eastern Time

DALLAS, May 31, 2023 — One in three adults with type 2 diabetes may have undetected cardiovascular disease.Elevated levels of two protein biomarkers indicative of cardiac injury were associated with undetected or no symptoms cardiovascular disease in adults type 2 diabetes compared to people without type 2 diabetes, according to a new study published in the journal TODAY. American Heart Association Journalan open access, peer-reviewed journal of the American Heart Association.

Sensitive cardiac troponin T and N-terminal pro-B-type natriuretic peptide biomarker assays are used to measure injury and stress to the heart.These tests are routinely used for diagnosis heart attack and heart failure. However, slightly elevated levels of these proteins in the bloodstream may be an early warning sign of changes in heart structure and function, which may increase the risk of heart failure in the future. coronary heart disease Or death.

“What we are seeing is that many people with type 2 diabetes who have no history of heart attack or cardiovascular disease are at increased risk of cardiovascular complications,” said study co-author Elizabeth Selvin, Ph.D. , MPH said. Professor of Epidemiology at the Johns Hopkins Bloomberg School of Public Health in Baltimore. “Across the population diagnosed with type 2 diabetes, which is about 27 million adults in the United States, according to the CDC, some people are at low risk of cardiovascular disease, while others are at high risk. So the open question is: ‘Who is most at risk? “These cardiac biomarkers provide insight into cardiovascular risk in people who might otherwise not be recognized as at highest risk.” ”

Researchers analyzed health information and blood samples from more than 10,300 adults collected as part of the US National Health and Nutrition Survey from 1999 to 2004. The aim was to determine whether previously unrecognized asymptomatic cardiovascular disease could be determined by elevated blood levels. Cardiac protein biomarkers with and without type 2 diabetes. Study participants did not report any history of cardiovascular disease at study entry.

The researchers used stored blood samples from all study participants to measure levels of two cardiac biomarkers. Mortality statistics were collected from the National Death Index. After adjusting for age, race, income, etc., cardiovascular risk factorsThey assessed the association between elevated troponin and N-terminal pro-B-type natriuretic peptide and the risk of cardiovascular or all-cause mortality.

The study found that:

• One-third (33.4%) of adults with type 2 diabetes had undetected signs of cardiovascular disease, as indicated by elevated levels of two protein markers, compared to adults without diabetes. was only 16.1%.
• In adults with type 2 diabetes, elevated levels of troponin and N-terminal pro-B-type natriuretic peptide were associated with an increased risk of all-cause mortality (77% and 78% increased risk, respectively) and cardiovascular mortality (54% and 78%). was associated with an increased risk of Each more than doubles the increased risk compared to normal levels of these proteins in the blood. This increased risk remained after adjusting for other cardiovascular risk factors.
• After adjusting for age, elevated troponin levels were more common in patients with type 2 diabetes overall and across age, gender, race/ethnicity and weight categories. In contrast, when adjusted for age, N-terminal pro-B-type natriuretic peptide levels were not elevated in patients with type 2 diabetes compared with those without type 2 diabetes.
• The prevalence of elevated troponin was significantly higher in people with long-standing type 2 diabetes and poorly controlled blood glucose levels.

“Cholesterol is often the factor we target to reduce the risk of cardiovascular disease in people with type 2 diabetes. “If type 2 diabetes causes direct damage to the heart’s small blood vessels independently of the accumulation of cholesterol plaques, cholesterol-lowering drugs will not prevent heart damage,” Selbin said. said. “Our study suggests that additional treatments other than statins are needed to reduce the risk of cardiovascular disease in people with type 2 diabetes.”

While much research has focused on studying how traditional risk factors such as high blood pressure and cholesterol affect cardiovascular health, new evidence suggests that specific cardiac biomarkers We suggest that screening 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. We may be able to focus on cardiovascular prophylaxis,” she added.

This is one of the first studies to use participants that truly represent the general population. However, this data did not identify heart disease, heart failure, stroke events, or cardiovascular complications, so we wondered whether routine measurement of these biomarkers could reduce cardiovascular complications in this population. Further research needs to be done to determine.

according to American Heart Association 2023 Statistical UpdateThere were 102,188 deaths in the United States in 2020, attributed to diabetes (including type 1 and type 2 diabetes), with an estimated 1.64 million deaths worldwide.

Co-authored by Dr. Michael Fang of MHS. Dan Wang, MS; Olive Tan, M.D., MHS; John William McEvoy, MB, B.Ch., BAO, MHS, M.Ed., Ph.D. Justin B. Echouffo-Tcheugui, MD, Ph. Dr. D. Robert H. Christenson Author disclosures are provided in the manuscript.

This study was funded by the Biomarker Consortium of the National Institutes of Health Foundation.

Research published in the American Heart Association scientific journal is peer-reviewed. Statements and conclusions in each manuscript are solely the opinions of the study authors and do not necessarily reflect the policies or positions of the Society. The Association makes no representations or warranties as to its accuracy or reliability. The association is primarily funded by individuals. Foundations and companies (including pharmaceuticals, device manufacturers, and other companies) also make donations to fund specific programs and events of the association. The Society has strict policies in place to ensure that these relationships do not affect scientific content. Revenues from pharmaceutical companies, biotechnology companies, device manufacturers, health insurers and overall financial information for the association are available. here.

Additional resources:

About the American Heart Association

The American Heart Association works tirelessly to help the world live longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Working with dozens of organizations and with the help of millions of volunteers, we fund groundbreaking research, advocate for public health, and share life-saving resources. The Dallas-based organization has served as a leading source of health information for nearly a century.Connect with us at heart.org, Facebook, twitter Or call 1-800-AHA-USA1.

###

Media Inquiries and AHA/ASA Expert Opinion: 214-706-1173

Karen Astle: 214-706 1392; [email protected]

General Inquiries: 1-800-AHA-USA1 (242-8721)

heart.org and stroke.org