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Biomarker predicts heart failure in type 2 diabetes
Adding N-terminal pro-B-type natriuretic peptide level to the list of traditional risk factors for heart failure substantially improved 5-year risk prediction among adults with type 2 diabetes, according to findings recently published in Diabetes Care.
“Diabetes is one of the major risk factors for heart failure, being associated with a more than 50% increase in risk, and has strong adverse effects on the prognosis of heart failure,” Toshiaki Ohkuma, PhD, of the George Institute for Global Health at the University of Sydney, Australia, and colleagues wrote. “Recently, several circulating biomarkers, such as C-reactive protein, interleukin-6, N-terminal pro-B-type natriuretic peptide and high-sensitivity cardiac troponin T, have been shown to be associated with the incidence of CVD. However, few studies have examined the association between these biomarkers and the risk of heart failure in patients with diabetes, and how well these biomarkers can classify the risk of heart failure in such patients is uncertain.”
Ohkuma and colleagues performed a nested case-cohort study, examining possible links between cardiac stress biomarkers and heart failure in 3,098 patients with type 2 diabetes. All patients had participated in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. Patients came from 215 treatment centers in 20 different countries.
After adjustment, higher levels of all biomarkers were linked with increased risk for incidence or progression of heart failure, the researchers reported. The HR was 3.06 for each 1-standard deviation increase in N-terminal pro-B-type natriuretic peptide (95% CI, 2.37-3.96), 1.5 (95% CI, 1.27-1.77) for high-sensitivity cardiac troponin T, 1.48 (95% CI, 1.27-1.72) for interleukin-6 and 1.32 for each 1-standard deviation increase in C-reactive protein (95% CI, 1.12-1.55).
Adding N-terminal pro-B-type natriuretic peptide to a model that included conventional risk factors “meaningfully improved” prediction of 5-year risk for heart failure, Ohkuma and colleagues wrote. This did not hold true for any of the other biomarkers included in the study.
“In conclusion, we found that interleukin-6, high-sensitivity C-reactive protein, high sensitivity cardiac troponin T and N-terminal pro-B-type natriuretic peptide were independent predictors of the incidence of heart failure in patients with type 2 diabetes,” the researchers wrote. “However, only the addition of N-terminal pro-B-type natriuretic peptide materially improved the predictive performance for heart failure beyond that from conventional clinical risk factors. Further studies are needed to validate our findings.” – by Andy Polhamus
Disclosure: Ohkuma reports no relevant financial disclosures. Please see the full study for a complete list of all other researchers’ relevant financial disclosures.