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A third of US citizens with Type 2 diabetes may have undetected cardiovascular disease, finds study


A new study published recently in the Journal of the American Heart Association found that two heart disease-related biomarkers were elevated in one-third of adults with Type 2 diabetes in the United States, suggesting that routine screening for these two cardiac biomarkers, as well as more customised therapies, may help to lower the incidence of cardiovascular disease events in this high-risk population.

The study also found that persons with Type 2 diabetes who do not have any signs or symptoms of cardiovascular disease have higher levels of two proteins linked to heart disease than those who do not have Type 2 diabetes.

High-sensitivity cardiac troponin T and N-terminal pro-B-type natriuretic peptide indicators are utilised to assess heart damage and stress and are commonly used to detect a heart attack or heart failure.

However, according to researchers, mildly raised levels of these proteins in the bloodstream may be an early warning indication of changes in the structure and function of the heart, thereby increasing the risk of future heart failure, coronary heart disease, or death.

“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,” the study co-author Dr Elizabeth Selvin, a professor of epidemiology at Johns Hopkins Bloomberg School of Public Health in Baltimore said.

“When we look at the whole population of people diagnosed with Type 2 diabetes, about 27 million adults in the United States, according to the CDC, some are at low risk and some are at high risk for cardiovascular disease, so the open question is who is most at risk,” she pondered.

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“These cardiac biomarkers give us a window into cardiovascular risk in people who otherwise might not be recognised as the highest risk,” Dr Elizabeth added.

Researchers examined health data and blood samples collected from more than 10,300 participants as part of the National Health and Nutrition Examination Survey from 1999 to 2004. The goal was to see if elevated levels of cardiac protein biomarkers in patients with and without Type 2 diabetes could predict previously undiagnosed cardiovascular disease with no symptoms.

Researchers examined the amounts of two cardiac biomarkers in preserved blood samples from all study participants. Using National Death Index was used to compile mortality statistics and examined the correlations between increased troponin and N-terminal pro-B-type natriuretic peptide with the risk of mortality from cardiovascular disease or all causes after accounting for age, race, income, and cardiovascular risk factors.

The study found that one-third (33.4%) of persons with Type 2 diabetes had symptoms of undiagnosed cardiovascular disease, as shown by higher levels of the two protein markers, compared to just 16.1% of those without diabetes.

When compared to normal levels of these proteins in the blood, elevated levels of these biomarkers were linked 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) in adults with Type 2 diabetes. According to the researchers, the greater risk remained after controlling for other cardiovascular risk factors.

Pointing out that doctors often target cholesterol as a factor to reduce the risk of cardiovascular disease in people with Type 2 diabetes, Dr Elizabeth said, “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,” she added.

She further emphasised that their research suggests that additional non-statin-related therapies are needed to lower the cardiovascular disease risk in people with Type 2 diabetes. 


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