Heart Failure Biomarkers Improve Prediction of Cardiovascular Disease Associated With Type 2 Diabetes


The investigators identified 4 prognostic factors with high predictive ability and supported by moderate to high strength evidence beyond what is already available for cardiovascular disease.

Thirteen biomarkers have been identified to accurately predict cardiovascular disease (CVD) risk in patients with type 2 diabetes (T2D), according to results of a analysis published in Communications Medicine.1,2

3d illustration of human heart and cardiogram on futuristic blue background | Image Credit: Artem - stock.adobe.com

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N-terminal pro b-type natriuretic peptide (NT-proBNP), currently used to monitor heart failure in patients, is the only biomarker ready to be evaluated for potential use in clinical practice for evaluating CVD risk.2

“More than 500 million [patients] worldwide live with diabetes,” Maria F. Gomez, PhD, a research group leader at the Lund University Diabetes Centre and professor of physiology at Lund University, said in the press release. “With numbers that high, it’s important to identify readily available ways to accurately classify patients so that those at higher risk of cardiovascular disease can receive the preventative care they need.”1

In the analysis, investigators identified 4 prognostic factors with high predictive ability and supported by moderate to high strength evidence; 3 factors with moderated ability, supported by low to moderate strength evidence; and 6 factors with low ability, supported by low to moderate evidence, according to the investigators.2

3 Key Takeaways

  1. N-terminal pro b-type natriuretic peptide (NT-proBNP), currently utilized for heart failure monitoring, stands out as the most promising biomarker ready for testing in clinical practice to evaluate CVD risk in T2D patients.
  2. Other biomarkers with notable predictability include TnT, TyG, and GRS-CHD, although the clinical application of some biomarkers is limited due to insufficient evidence, highlighting the importance of further research and validation.
  3. The analysis was conducted collaboratively by 23 experts from 11 countries, representing institutions such as The Johns Hopkins University, the Chinese University of Hong Kong, and Lund University.

The investigators used medical studies that were published from 1990 and onward to determine the difference between those with T2D who experienced CVD and those who did not, according to the press release.1 They used 321 biomarkers to find the 13 biomarkers significantly associated with CVD.1

“Our goal was to identify promising markers that could improve cardiovascular risk prediction in people with [T2D],” Nestoras Mathioudakis, MD, MHS co-medical director of the Johns Hopkins Medicine Diabetes Prevention & Education Program and an associate professor of medicine at the Johns Hopkins University School of Medicine, said in a press release. “We wanted to look beyond traditional prognostic factors like hypertension and smoking.”1

They noted that NT-proBNP had the highest association. In several studies, the investigators found that higher levels of NT-proBNP were associated with a higher risk of CVD. In 1 study, investigators found that in 16,000 individuals, there was a 64% hazard rate increase for every standard deviation of NT-proBNP, according to the press release.1

The other 3 biomarkers with the highest predicability were TnT, TyG, and GRS-CHD, according to the results of the analysis.2 However, investigators said that the remaining biomarkers were not “adequately tested or compared against established CVD risk factors.” Further, there were some biomarkers that did demonstrate the capability of predicting CVD beyond what is currently available, but the clinical application in practice is limited due to inadequate evidence, the study investigators said.2

“The 13 biomarkers, especially NT-proBNP, warrant further testing to evaluate their potential,” Ronald Ma, MB BChir, FRCP, FHKCP, FHKAM, SH Ho Professor of Diabetes at the Chinese University of Hong Kong, said in the press release. “If future studies confirm their value in predicting cardiovascular risk in patients with [T2D], we may be able to change standards of care.”1

The analysis was conducted by 23 experts from 11 countries, with institutions including The Johns Hopkins University in Maryland, the Chinese University of Hong Kong in Hong Kong, and Lund University in Sweden.1


  1. International consortium identifies biomarkers that improve prediction accuracy of cardiovascular disease risk in patients with type 2 diabetes. News release. EurekAlert. January 25, 2024. Accessed February 2, 2024. https://www.eurekalert.org/news-releases/1032413
  2. Ahmad A, Lim LL, Morieri ML, Ha-Ting Tam, C, et al. Precision prognostics for cardiovascular disease in Type 2 diabetes: a systematic review and meta-analysis. Commun Med (Lond). 2024;4(1):11. doi:10.1038/s43856-023-00429-z
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