Novel Biomarkers Predict CV Events in Type 2 Diabetes

Cardiovascular disease generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke. Cardiovascular disease (CVD) risk prediction represents an increasing clinical challenge in the treatment of diabetes.

A panel of vascular imaging, functional assessments, and biomarkers reflecting different disease mechanisms has been used to identify clinically useful markers of risk for cardiovascular (CV) events in subjects with type 2 diabetes (T2D) with or without manifest CVD.

A team of scientists led by those at the University of Exeter (Exeter, UK) recruited 936 subjects with T2D at four European centers. Carotid intima-media thickness and plaque area, ankle-brachial pressure index, arterial stiffness, endothelial function, and circulating biomarkers were analyzed at baseline, and CV events were monitored during a three-year follow-up period.

The investigators reported that the CV event rate in 440 subjects with T2D was statistically higher in those with than in those 496 without manifest CVD at baseline (5.53 versus 2.15/100 life-years). New CV events in subjects with T2D with manifest CVD were associated with higher baseline levels of inflammatory biomarkers such as interleukin 6, chemokine ligand 3, pentraxin 3, and high sensitivity C-reactive protein (hs-CRP) and endothelial mitogens represented by, hepatocyte growth factor and vascular endothelial growth factor A. However, CV events in subjects with T2D without manifest CVD were associated with more severe baseline atherosclerosis (median carotid plaque area 34.5 mm2 versus 19.5 mm2. Conventional risk factors, as well as measurements of arterial stiffness and endothelial reactivity, were not associated with CV events.

The authors concluded that their observations demonstrate that markers of inflammation and endothelial stress reflect CV risk in subjects with T2D with manifest CVD, whereas the risk for CV events in subjects with T2D without manifest CVD is primarily related to the severity of atherosclerosis. The study was published on July 6, 2018, in the journal Diabetes Care.

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