In a recent study, the American Heart Association indicated that one in three adults with T2DM may have undetected CVD.

The recent research, published in the Journal of the American Heart Association, indicated that elevated levels of two protein biomarkers indicating heart damage were associated with undetected or symptomless CVD in adults with T2DM compared with those without T2DM.

The authors wrote, “Our primary objective was to characterize the national prevalence of subclinical CVD, assessed by elevated hs-cTnT (high-sensitivity cardiac troponin T) and NT-proBNP, in U.S. adults with and without diabetes. We estimated prevalence overall and by demographic characteristics, diabetes duration, and glycemic control.”

They also examined the independent associations of the cardiac biomarkers with all-cause and cardiovascular mortality in adults with diabetes. They also noted that the secondary objective was to assess, in individuals with diabetes, the prevalence and prognostic importance of elevated hs-cTnI (high-sensitivity cardiac troponin I) measured using three different assays.

Using stored serum samples from the 1999 to 2004 National Health and Nutrition Examination Survey, researchers measured hs-cTnT and NT-proBNP (N-terminal pro-B-type natriuretic peptide). The study population involved adults aged 20 years or older with no self-reported CVD (i.e., heart attack, stroke, coronary heart disease, or heart failure) who had valid measures of NT-proBNP, hs-cTnT, and covariates.

Among U.S. adults without a history of CVD (n = 10,304), the authors estimated the prevalence of elevated hs-cTnT (≥14 ng/L) and NT-proBNP (≥125 pg/mL) in those with and without diabetes. After modification for demographics and traditional CVD risk factors, they also examined the relationships between elevated hs-cTnT and NT-proBNP with all-cause and CVD mortality.

The results revealed that the estimated prevalence of subclinical CVD (elevated hs-cTnT or NT-proBNP) was approximately two times higher in adults with (versus without) diabetes (33.4% vs. 16.1%, respectively). After age adjustment, elevated hs-cTnT—not elevated NT-proBNP—was more frequent in those with diabetes overall and across age, gender, race and ethnicity, and weight status. Moreover, the prevalence of elevated hs-cTnT was substantially greater in those with longer diabetes duration and worse glycemic control. Among those with T2DM, elevated hs-cTnT and NT-proBNP were independently linked with all-cause mortality (adjusted hazard ratio [HR], 1.77 [95% CI, 1.33-2.34] and HR, 1.78 [95% CI, 1.26-2.51]) and CVD mortality (adjusted HR, 1.54 [95% CI, 0.83-2.85] and HR, 2.46 [95% CI, 1.31-4.60]).

Based on their findings, the authors wrote, “Approximately 1 in 3 adults with diabetes had subclinical CVD, with 19% having elevated levels of hs-cTnT, 23% having elevated NT-proBNP, and 9% having elevations in both cardiac biomarkers. These results highlight the substantial burden of subclinical CVD in persons with diabetes and emphasize the importance of early detection and treatment of CVD for this high-risk population.”

The authors concluded that subclinical CVD was independently correlated with an augmented mortality risk, and routine testing of cardiac biomarkers may be beneficial for evaluating and monitoring CVD risk in individuals with T2DM in the general population.

Study coauthor Elizabeth Selvin, PhD, MPH, a professor of epidemiology at Johns Hopkins Bloomberg School of Public Health in Baltimore, stated, “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. When we look at the whole population of people diagnosed with type 2 diabetes, about 27 million adults in the U.S., 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?’ These cardiac biomarkers give us a window into cardiovascular risk in people who otherwise might not be recognized as highest risk.”

Dr. Selvin also stated, “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. Our 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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