13 new biomarkers could help better predict heart disease risk in people with type 2 diabetes

An international academic consortium has identified 13 biomarkers that significantly improve the ability to accurately predict cardiovascular disease risk in people with type 2 diabetes. The analysis, conducted by 23 experts from 11 countries, was conducted by Johns Hopkins University in the United States, the Chinese University of Hong Kong in Hong Kong and Lund University in Sweden.

Although people with type 2 diabetes are twice as likely to develop CVD than those without diabetes, it is challenging for clinicians to predict who in this population is most at risk. Traditional risk scores, which reflect the level of risk in the presence of certain risk factors, have become outdated and do not perform well in different populations.

Over 500 million people worldwide live with diabetes. With numbers this high, it is important to identify readily available ways to accurately classify patients so that those at higher risk of CVD receive the preventive care they need.”

Maria F. Gomez, Ph.D., co-senior author of the analysis, head of the research group at Lund University Diabetes Center and professor of physiology at Lund University

With this in mind, the research team reviewed and analyzed medical studies published from the year 1990 onwards that investigated the differences between people with type 2 diabetes who developed cardiovascular disease and those who did not.

“Our goal was to identify promising markers that could improve the prediction of cardiovascular risk in people with type 2 diabetes,” says Nestoras Mathioudakis, MD, MHS, co-senior author of the analysis, co-medical director of Johns Hopkins Medicine Diabetes Prevention & Education Program, and associate professor of medicine at the Johns Hopkins University School of Medicine. “We wanted to look beyond traditional predictors such as hypertension and smoking.”

From a review and analysis of the published medical literature, the team extracted data on 321 biomarkers and found that 13 were significantly associated with cardiovascular risk in people with type 2 diabetes. The standout biomarker was N-terminal pro b-type natriuretic peptide ( NT-proBNP), which is currently used to monitor heart failure status in patients. The team found that, in several studies, higher levels of NT-proBNP in the body correlated with a higher risk of cardiovascular disease. A study of 16,000 patients the team reviewed found a 64% increase in hazard rate for every standard deviation increase in NT-proBNP.

“The 13 biomarkers, especially NT-proBNP, warrant further testing to assess their potential,” says Ronald Ma, MBBChir., FRCP, FHKCP, FHKAM, co-senior author of the analysis and SH Ho Professor of Diabetes at Chinese University Hong Kong. “If future studies confirm their value in predicting cardiovascular risk in patients with type 2 diabetes, we may be able to change the standard of care.”

The study was conducted as part of the Precision Medicine in Diabetes initiative, an international collaboration between the American Diabetes Association and the European Association for the Study of Diabetes.

The analysis was published on January 22 at Communication Medicine.