Study Finds 1 in 3 Adults with Type 2 Diabetes May Have Undetected Cardiovascular Disease

A new study from the American Heart Association (AHA) found that 1 in 3 adults with type 2 diabetes may have undetected cardiovascular disease.

“Adults with type 2 diabetes who do not have any signs or symptoms of cardiovascular disease are more likely to have elevated levels of two proteins linked to heart disease than their peers without type 2 diabetes,” Elizabeth Selvin, PhD, MPH, study co-author and professor of epidemiology at Johns Hopkins Bloomberg School of Public Health in Baltimore, told Health.

“These cardiac biomarkers are associated with an increased risk of death from any cause and also death from cardiovascular disease,” she said.

Selvin and fellow researchers analyzed health information and blood samples of more than 10,300 adults, gathered from the U.S. National Health and Nutrition Examination Survey from 1999 to 2004. The participants did not have a history of cardiovascular disease when participating in the study.

By analyzing the blood samples of the study participants, researchers measured levels of the cardiac biomarkers troponin and N-terminal pro-B-type natriuretic peptide (NT-proBNP). They also looked at mortality statistics from the National Death Index. Based on both analyses, they determined associations between elevated troponin and NT-proBNP with risk of death from cardiovascular disease or death from all causes.

In addition to discovering that one-third of adults with type 2 diabetes had signs of undetected cardiovascular disease, the study also found the below:

• Among adults with type 2 diabetes, elevated levels of the two biomarkers were associated with an increased risk of all-cause death and cardiovascular death.
• After adjusting for age, elevated levels of troponin were more common in people with type 2 diabetes overall and across categories of age, sex, race/ethnicity, and weight. However, when adjusted for age, NT-proBNP levels were not elevated in people with type 2 diabetes compared to those without the condition.
• Elevated troponin was significantly higher in people who had type 2 diabetes for a longer period of time and whose blood sugar levels were not well-controlled.

While high blood pressure and cholesterol are established ways to assess cardiovascular health, Selvin and colleagues believe their findings suggest that routine screening for cardiac biomarkers and tailored interventions may help to reduce the risk of cardiovascular disease in people with type 2 diabetes. However, they note further studies are still needed. 

“Cardiovascular disease can be present for a long time before patients experience signs or symptoms of the disease,” Selvin explained. “Our study demonstrates that cardiac biomarkers measured in a blood sample can ‘unmask’ cardiovascular disease that would not otherwise be recognized.”

Diabetes and Heart Disease

Research has well-established that type 2 diabetes is a driver of cardiovascular disease, said Karl Nadolsky, DO, endocrinologist and diplomate at the American Board of Obesity Medicine. 

“Type 2 diabetes has been suggested to be basically equivalent to having expected established atherosclerotic disease, though obviously there are many individual factors and disease burden,” he told Health.

Dr. Nadolsky explained that in people with type 2 diabetes, obesity driving insulin resistance can lead to dyslipidemia, hypertension, hyperglycemia, and an inflammatory state that increases the risk of atherosclerosis—thickening of the arteries—leading to heart attacks and strokes. 

Atherosclerosis, especially if it results in a heart attack, can also cause structural heart disease with heart failure.

Although the connection of heart disease in those with type 2 diabetes has been established for some time, Dr. Nadolsky noted that any data-driven reminder—like the AHA study—can help solidify the importance of monitoring heart health in those with type 2 diabetes.

Type 2 Diabetes and Heart Disease Risk

In the recent AHA study, researchers looked at FDA-cleared tests, which are commercially available from most laboratories. However, Selvin pointed out that clinical guidelines are not yet clear on when and how to use the tests for routine screening in the general population.

Dr. Nadolsky added that it’s not currently recommended to perform screening for atherosclerotic cardiovascular disease if a person is asymptomatic because “the risk is already expected to be high or even subclinically ‘established,’ so the conglomerate of risk factors are the focus of therapy to optimize and minimize the risk of events.”

However, the risk of heart failure is now thought to be high enough that annual screening of markers (like NT-proBNP) can help guide whether echocardiograms should be administered to treat heart failure more aggressively.

Guidelines from the American Association of Clinical Endocrinologists (AACE) and the American Diabetes Association (ADA) standards recommend intensive therapy known to reduce cardiovascular risk, such as nutrition, exercise, obesity treatment (weight loss therapies), glycemic control, lipid goals, and blood pressure goals.

“We have medications for all aspects of cardiovascular risk factors and glucose-lowering therapies known to have a cardiovascular benefit that can and should be prioritized,” Dr. Nadolsky emphasized.

He added that it’s critical for physicians and people living with type 2 diabetes to acknowledge the increased cardiovascular risk of obesity and approach treatment with individualized risk evaluation and therapy.

Dr. Nadolsky concluded that “it requires a comprehensive team approach for a truly, ‘holistic,’ treatment plan for patients at high risk with an emphasis on improving nutrition, physical activity/exercise, sleep, and medications shown to reduce cardiovascular event risk that addresses obesity, hyperglycemia, hypertension, lipids and more.”