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

May 31, 2023 — If you have type 2 diabetes, you may already be at higher risk of developing 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.

“Biomarkers” can be detected in the blood before a person has symptoms of heart disease. They could be used to screen people for higher risks earlier, at a time when prevention or treatment efforts could be most effective, the researchers said.

Study senior author Elizabeth Selvin, PhD, MPH, professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health in Baltimore, said.

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

It is mainly measured in hospitals to test people with chest pain and/or shortness of breath. They’re not generally used to identify heart disease — but emerging data like this study suggest they may have a role in prevention or predicting risk, said Vijay Nambi, a cardiologist at Baylor College of Medicine in Houston.

This current study tested stored blood samples from a more diverse, nationally representative cohort of 10,304 adults aged 20 years or older. For example, those with type 2 diabetes were 60% non-Hispanic white, 15% non-Hispanic black, 9% Mexican-American, and 16% of one or another race.

The subjects in the study did not report any heart disease when they entered the National Health and Nutrition Examination Survey (NHANES) project between 1999 and 2004. Returning to blood samples stored about two decades ago allowed Selvin and his colleagues to track deaths from heart disease or any disease. other. In the national mortality index until the end of 2019.

Cardiac risk screening

Selvin and his colleagues not only identified the things that lead to increased risk, but suggested what could be done about it.

“Our findings support the potential use of these cardiac biomarkers for routine monitoring of risk, particularly in high-risk groups where we may use them to help design cardiovascular therapy,” Selvin said.

Nambi agreed that using the biomarker results to tailor management to the individual “would be more powerful and impactful.”

Selvin said taking blood from people with type 2 diabetes to test for these two things can help prioritize who is treated with a sodium glucose transporter 2 (SLGT2) inhibitor. Drugs in the SLGT2 class include canagliflozin, dapagliflozin, and empagliflozin. The findings 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.

Selvin said more research is needed.

“We need to understand how best to use cardiac biomarkers in routine practice to improve the lives of people with diabetes and other individuals at risk of cardiovascular disease,” she said. “Intervention studies and clinical trials may be particularly useful in providing information for best practices in this field.”