A new study reveals an early warning sign, which may increase the risk of future heart failure, coronary heart disease, or death in people with Type 2 Diabetes.
In managing the risk of cardiovascular disease among individuals with Type 2 diabetes, cholesterol is commonly targeted as a key factor. However, it is important to note that Type 2 diabetes can potentially impact the heart in ways that are unrelated to cholesterol levels. This suggests that solely relying on statin treatment, which primarily aims to lower cholesterol, may be ineffective in addressing these specific effects of Type 2 diabetes on the heart.
Newly published research in the Journal of the American Heart Association sheds light on a concerning discovery – 1 in 3 adults with Type 2 diabetes may unknowingly harbor undetected cardiovascular disease. The study found a significant association between elevated levels of two specific protein biomarkers, high-sensitivity cardiac troponin T and N-terminal pro-B-type natriuretic peptide, and the presence of symptomless or undetected cardiovascular disease in individuals with Type 2 diabetes, compared to those without the condition.
Typically, these protein biomarkers are employed in diagnosing heart attack and heart failure, as they indicate injury and stress to the heart. However, the research suggests that even mildly increased concentrations of these proteins in the bloodstream can serve as an early warning sign of structural and functional changes in the heart. Such changes pose a heightened risk of future heart failure, coronary heart disease, or even mortality.
Co-author Elizabeth Selvin says that “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.”
Considering the entire population of individuals diagnosed with Type 2 diabetes, which amounts to approximately 27 million adults in the United States, the Centers for Disease Control and Prevention (CDC) reveals a range of cardiovascular disease risks. This leads to a critical question: “Who is most at risk?”
“These cardiac biomarkers,” according to the author, “give us a window into cardiovascular risk in people who otherwise might not be recognized as highest risk.”
A comprehensive analysis was conducted on health data and blood samples from over 10,300 adults who participated in the U.S. National Health and Nutrition Examination Survey between 1999 and 2004. The primary objective of this study was to investigate whether elevated levels of cardiac protein biomarkers could indicate the presence of previously undetected cardiovascular disease in individuals with and without Type 2 diabetes, even in the absence of symptoms. All participants in the study reported no history of cardiovascular disease at the time of enrollment.
By utilizing stored blood samples from the entire cohort, the researchers measured the levels of two specific cardiac biomarkers. To gather mortality data, statistics were obtained from the National Death Index. After adjusting for factors such as age, race, income, and cardiovascular risk factors, the researchers examined the associations between elevated troponin and N-terminal pro-B-type natriuretic peptide levels and the risk of death due to cardiovascular causes or any other causes.
The findings of the study are as follows:
- Adults with Type 2 diabetes displayed signs of undetected cardiovascular disease at a rate of 33.4%, as indicated by elevated levels of the two protein markers. In comparison, only 16.1% of individuals without diabetes exhibited similar signs.
- Among adults with Type 2 diabetes, elevated levels of troponin and N-terminal pro-B-type natriuretic peptide were linked to an increased risk of death from any cause, with a 77% and 78% elevated risk, respectively. Moreover, these elevated levels were associated with a 54% increased risk of cardiovascular death, which more than doubled the risk. These associations persisted even after accounting for other cardiovascular risk factors.
- When age was factored in, elevated levels of troponin were more prevalent in individuals with Type 2 diabetes across different age groups, genders, racial/ethnic backgrounds, and weight categories. However, N-terminal pro-B-type natriuretic peptide levels did not show elevated values in individuals with Type 2 diabetes compared to those without, once age adjustments were made.
- The prevalence of elevated troponin was significantly higher in individuals who had Type 2 diabetes for a longer duration and who had poorly controlled blood sugar levels.
“Type 2 diabetes may have a direct effect on the heart not related to cholesterol 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 adds. “Our research suggests that additional non-statin-related therapies are needed to lower the cardiovascular disease risk in people with Type 2 diabetes.”
Extensive research has primarily concentrated on investigating the impact of conventional risk factors like high blood pressure and cholesterol on cardiovascular health. Nevertheless, emerging evidence indicates the importance of integrating screening for specific cardiac biomarkers into the regular assessment of traditional cardiovascular risk factors. This suggests a need to expand the scope of routine evaluations to include these biomarkers in order to enhance the understanding and management of cardiovascular health.
“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 explains.
This study represents one of the initial research endeavors utilizing a participant pool that accurately represents the broader population. However, due to the limitations of the available data, such as the inability to identify specific cardiovascular events like heart disease, heart failure, stroke, or other complications, further investigations are necessary to determine whether routine measurement of these biomarkers could potentially reduce cardiovascular complications within this demographic.
According to the American Heart Association’s 2023 Statistical Update, diabetes (including both Type 1 and Type 2 diabetes) was linked to 102,188 deaths in the United States in 2020. Globally, an estimated 1.64 million deaths were attributed to diabetes during the same period.
Source: 10.1161/JAHA.122.029083
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