Ten risk biomarkers may help predict cardiovascular outcomes in type 2 diabetes

A panel of ten biomarkers might be of research value to help identify type 2 diabetes patients with high cardiovascular risk when added to routine clinical risk factors, a new research has found.
The candidate biomarkers were first successfully used in study participants with abnormal blood sugar levels (dysglycemia) from the Outcome Reduction with an Initial Glargine Intervention (ORIGIN) trial.
In the latest research, these biomarkers showed effectiveness in helping to predict cardiovascular outcomes in type 2 diabetes patients involved in the Heart Outcomes Prevention Evaluation (HOPE) study.
The ORIGIN trial biomarkers published in the journal Circulatio, include, among others, apolipoprotein B, which predicts cardiovascular events better than standard lipid levels, and angiopoietin protein 2, which is involved in blood vessel growth in disease and is a good indicator of diabetes complications.
The findings from McMaster University, which were presented at the European Association for the Study of Diabetes (EASD) 2016 annual meeting, demonstrate that the biomarkers do not replace existing clinical risk factors, but they enhance the prediction of cardiovascular events over using clinical risk factors alone.
Hertzel Gerstei, the study’s lead investigator, identified the biomarkers while conducting the ORIGIN trial in 2015, which examined the cardiovascular safety of using insulin glargine (Lantus) early on in the course of treatment in patients with dysglycemia.
At the time, Gerstein and his colleagues wanted to know whether other blood tests, in addition to routine clinical risk factors, increased the ability to differentiate people with high risk of cardiovascular disease.
To that end, the researchers then conducted the HOPE study, where they tested how the emerging risk biomarkers performed in a totally different trial population of 350 type 2 diabetes patients.
They took the biomarkers with their risk scores plus the standard clinical risk factors, as used in ORIGIN, and assessed cardiovascular outcomes in HOPE.
The results revealed that all biomarkers but one (chromogranin A) seemed to predict cardiovascular events with hazard ratios highly consistent with those seen in ORIGIN.
In type 2 diabetes patients, circulating levels of angiopoietinlike protein 2, for instance, were associated with major adverse cardiac events (MACE) and death.
The refinement in risk prediction may also tell physicians to treat patients differently, for example, more aggressively.
Elevated levels of one marker, called N-terminal pro-B-type natriuretic peptide (NT-proBNP), meant that the therapy of a type 2 diabetes patient needed to be intensified with blood pressure medication and beta-blockers.
These findings suggest that blood tests for these markers could soon help better determine patients’ risk of cardiovascular disease end points, such as risks of myocardial infarctio, stroke, or cardiovascular death.