A new risk score using two blood tests along with widely available clinical measurements was highly effective in predicting the risk for hospitalization for heart failure in people with type 2 diabetes, according to a new study published in the journal Diabetes Care.
Traditionally, cardiovascular risk scores that are used in people with type 2 diabetes have aimed to predict events — like heart attack and stroke — that are linked to atherosclerosis, or the narrowing of blood vessels due to the buildup of a fatty material called plaque. But heart failure, in which the heart can’t adequately supply blood to the body, is also a major risk in people with type 2 diabetes — and is linked to a much higher risk for death, as noted in a Healio article on the new study. This means that screening for heart failure risk in people with type 2 may be an important way to reduce deaths — especially since highly effective treatments are now approved for heart failure treatment in people with or without type 2 diabetes.
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For the latest study, researchers created a risk score for hospitalization related to heart failure that incorporated several measurements — including clinical measures like prior heart failure, coronary artery disease, atrial fibrillation, estimated glomerular filtration rate (eGFR, a measure of kidney function), and urine albumin-to-creatinine ratio, which are widely used to assess heart failure risk. They also added two new blood measurements to this mix — known as high-sensitivity troponin T (hsTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP). These two additional measurements, along with traditional clinical measures, were analyzed in the placebo group (non-treatment group) of a large clinical trial that looked at cardiovascular outcomes in people at high risk for heart disease.
The researchers looked at data from 6,106 participants who received a placebo (inactive pill) and had cardiovascular outcomes tracked as part of a trial looking at how a diabetes drug affected heart attack risk — but also included data on heart failure hospitalizations. They found that using only three variables was most effective at predicting the risk for heart failure hospitalization — the newly added biomarkers, along with a prior diagnosis of heart failure. A score using only these three data points effectively predicted the heart failure hospitalization risk — both in the original group used to create the score, and in a second group of participants from another clinical trial who took a placebo and had cardiovascular outcomes measured.
The second clinical trial, used to confirm the effectiveness of the new score, was designed to evaluate the type 2 diabetes drug Farxiga (dapagliflozin) as a treatment for heart failure in the active (not placebo) group of the trial. The researchers noted that in this group, taking Farxiga reduced the rate of heart failure hospitalization by only 2% in people with a low risk score (using the new score), by 36% in people with an intermediate risk score, by 37% in people with a high risk score, and by 28% in people with a very high risk score — indicating that the new score could be used to predict who would benefit most from this now-approved treatment for heart failure.
More studies of this new score, looking at its effectiveness in predicting heart failure hospitalization in even more groups of people, will likely be needed before it is widely used as an assessment in people with type 2 diabetes. But doctors could start using it right away as part of a decision to prescribe Farxiga to people at highest risk for severe outcomes related to heart failure.
Want to learn more about protecting your heart? Read “Be Heart Smart: Know Your Numbers,” “Does Diabetes Hurt Your Heart?” “Fight Off Heart Disease With These Five Heart-Healthy Foods” and “Lower Your Risk of Heart Disease.”