Improved heart attack prediction for diabetics
Australian researchers have found a simple screening test that boosts the ability to predict heart attacks and death in people with type 2 diabetes.
Lead author Associate Professor Graham Hillis, of The George Institute for Global Health and The University of Sydney, said the study had found that two biomarkers, High-Sensitivity Cardiac Troponin T and N-Terminal Pro-B-Type Natriuretic Peptide, appeared to greatly improve the accuracy with which the risk of cardiovascular events or death can be estimated in patients with type 2 diabetes.
“The addition of either marker improved the prediction of major cardiovascular events within the next five years. Likewise, both markers greatly improved the accuracy with which the five-year risk of death was predicted.
“The combination of both markers provided optimal risk discrimination.”
In contrast, levels of total cholesterol or high-sensitivity C-reactive protein provided minimal additional prognostic information, he said.
Diabetes is the world’s fastest-growing chronic disease. In 2013, 382 million people had diabetes in 2013; a figure expected to almost double to 592 million by 2031. About 956,000 Australians have type 2 diabetes, which is diagnosed in up to 90 per cent of all diabetics.
The study is important because the incidence of heart attacks is increased twofold to threefold in patients with type 2 diabetes, to the point that about two in every three patients with the condition will die due to cardiovascular disease.
“Simple screening tests that better detect high risk Type 2 diabetes patients would be particularly valuable,” said Associate Professor Graham Hillis.
“Accurate risk stratification allows treatments to be targeted to individuals who may derive particular benefit from interventions such as more intensive blood pressure lowering or statin therapy. Biomarkers might also identify a subgroup of patients who have the most to gain from antiplatelet therapy or those that require additional cardiovascular investigations such as echocardiography or stress testing.
“These potential uses remain, however, untested.”
Existing risk prediction methods, he said, were imperfect, and classical cardiovascular risk factors were relatively poor predicators in patients with diabetes.
Although intensive multifactorial interventions could reduce the complications of diabetes, the costs of such strategies could exceed the resources of even the most affluent health system, he said.
The study looked at 3,862 patients who participated in the Action in Diabetes and Vascular Disease (ADVANCE) trial, and was published in Diabetes Care.
See “The Relative and Combined Ability of High-Sensitivity Cardiac Troponin T and N-Terminal Pro-B-Type Natriuretic Peptide to Predict Cardiovascular Events and Death in Patients With Type 2 Diabetes” Diabetes Care January 2014 37:295-303; published ahead of print October 2, 2013, doi:10.2337/dc13-1165 at http://care.diabetesjournals.org/content/current.
17 January 2014.