One third of US adults with diabetes has early cardiovascular disease, which can be identified by two cardiac biomarkers.
One in three adults with diabetes living in the United States has a high burden of early heart disease, explains Michael Fang, PhD. “Our study is the first to demonstrate this burden,” he says. “In it, we highlight the potential usefulness of routine testing to monitor risk in these patients. This is important because more than 27 million people in the US have been diagnosed with diabetes, and heart disease remains the main cause of morbidity and mortality in people with T2D.”
For a study published in the Journal of the American Heart Association, Dr. Fang and colleagues sought to examine the burden and prognostic value of cardiovascular disease (CVD) based on cardiac biomarkers among US adults with and without diabetes. “We were interested in the percentage of adults with T2D who had early heart disease, and we went into the study thinking that this percentage would be high.”
CVD Is Leading Cause of Death in Diabetes
The study team suspected this would be the case for two reasons. “First, prior community-based studies have shown that elevations of specific cardiac biomarkers are common in people with diabetes,” Dr. Fang says. “Second, we know that CVD is the leading cause of death and morbidity in people with diabetes, accounting for more than 40% of hospitalizations and 30% of deaths. Nonetheless, it was a bit jarring to see the actual percentage, 33% (Figure).”
Dr. Fang and colleagues conducted these analyses by measuring two cardiac biomarkers —cardiac troponin and N-terminal pro-B-type natriuretic peptide—in a nationally representative sample of US adults. “These are typically used in clinical practice to diagnose patients experiencing acute cardiac events,” Dr. Fang says. “However, we found about one in three adults with diabetes had elevated levels of these markers. This is a substantial burden of subclinical/early CVD in people with diabetes in the general population.”
ADA Suggests Annual Screening for Cardiac Biomarkers
For endocrinologists and cardiologists who treat patients with T2D, the researchers stress two courses of action. “The first action is screening,” Dr. Fang says. “The American Diabetes Association (ADA) recommends screening for the aforementioned cardiac biomarkers on an annual basis in patients with diabetes. More frequent use of these tests in routine care may help identify patients at the highest risk.”
The second action, he notes, is therapy. “Once patients with elevated biomarkers are identified, it may be critical to initiate or intensify cardiovascular risk management,” he says. “This includes lifestyle interventions and the use of traditional therapies, such as statins and blood pressure–lowering medications, and newer therapies, such as sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists.”
These findings, the study group notes, have implications for screening and treatment intensification. “We have tests that can help us identify patients who are at highest risk and then connect them with effective therapies, which can potentially reduce their overall CVD risk,” Dr. Fang says.
Dr. Fang and colleagues would like to see alignment between different clinical guidelines. “While the ADA recommends the use of these tests in routine care, cardiology guidelines do not,” Dr. Fang points out. “Greater alignment between major medical organizations may reduce confusion for clinicians and facilitate implementation.”
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