About 1 in 3 with diabetes have an unknown heart risk: study

May 31, 2023 – If you have type 2 diabetes, you may already be at a higher risk for heart disease without knowing it. About a third of people with diabetes in a new study had higher levels of two things in their blood that are linked to heart disease.

These “biomarkers” in the blood can be detected before someone has symptoms of heart disease. So they could be used to screen people for higher risk earlier, at a time when prevention efforts or treatments may be more effective, researchers said.

“People with diabetes should be aware that they are at high cardiovascular risk and should work with their physician to develop a treatment plan that can prevent the future occurrence of cardiovascular events,” says senior study author Elizabeth Selvin, PhD, MPH, a professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

Historically, bad cholesterol has been blamed for a higher risk of cardiovascular disease in people with type 2 diabetes. This study suggests that something else is going on and that other types of treatments — besides those that lower cholesterol — should be considered.

They are mainly measured in hospitals to test people with chest pain and/or shortness of breath. They are not generally used to identify heart disease, but emerging data such as this study suggest they may play a role in preventing or predicting risk, said Vijay Nambi, MD, a cardiologist at Baylor College of Medicine in Houston.

This current study tested stored blood samples from a more diverse, nationally representative group of 10,304 adults ages 20 and older. For example, of those with type 2 diabetes, 60% were non-Hispanic White, 15% non-Hispanic Black, 9% Mexican American, and 16% were of another race or ethnicity.

People in the study did not report heart disease when they participated in the National Health and Nutrition Examination Survey (NHANES) project between 1999 and 2004. By going back to stored blood samples from about 2 decades ago, Selvin and colleagues were able to predict deaths from heart disease. or other ailments. cause in the National Death Index until the end of 2019.

Screening for heart risk

Selvin and colleagues not only identified things that cause the higher risk, but also suggested what could be done about it.

“Our findings support the potential use of these cardiac biomarkers for routine risk monitoring, especially in high-risk populations, where we could use them to help tailor cardiovascular therapy,” Selvin said.

Using biomarker results to tailor management to an individual “would be even more powerful and effective,” agreed Nambi.

Taking a blood sample from people with type 2 diabetes to test for these two things could help prioritize who is being treated with a sodium-glucose cotransporter-2 (SLGT2) inhibitor, Selvin said. Drugs in the SLGT2 class include canagliflozin, dapagliflozin, and empagliflozin. The results could also guide treatment with a glucagon-like peptide-1 (GLP-1) receptor agonist. GLP-1 drugs such as semaglutide (Ozempic) and liraglutide (Victoza 3-Pak) have received a lot of attention recently for their weight loss potential.

More research is needed, Selvin said.

“We need to understand how best to use cardiac biomarkers in everyday practice to improve the lives of people with diabetes and other individuals at high risk of cardiovascular disease,” she said. “Intervention studies and clinical trials can be particularly helpful in informing best practices in this area.”