Biomarker score predicts heart failure risk with diabetes and prediabetes

The score, which was based on cardiac troponin, N-terminal pro-B-type natriuretic peptide, C-reactive protein, and electrocardiography, could be used to target specific therapies to the highest-risk patients, study authors said.

A risk score for predicting heart failure in patients with diabetes or prediabetes was proposed by a recent study.

The study included 6,799 participants from previously conducted large observational studies (Atherosclerosis Risk In Communities, Dallas Heart Study, and the Multi-Ethnic Study of Atherosclerosis). At baseline, 33.2% had diabetes, 66.8% had prediabetes, and none had cardiovascular disease.

Their risk of developing heart failure was predicted using levels of cardiac troponin (high-sensitivity T ≥6 ng/L), N-terminal pro-B-type natriuretic peptide (≥125 pg/mL), and C-reactive protein (≥3 mg/L), and the presence of left ventricular hypertrophy on electrocardiography, with a point for each abnormal parameter. Results were published by JACC: Heart Failure on Jan. 6.

The five-year risk of heart failure increased in a graded fashion with the biomarker score. The risk with a score of one or zero was comparable to participants with euglycemia (0.78%). The highest risk was among those with a scores of 3 or 4 (12.0% in those with diabetes, 7.8% in those with prediabetes.

“Together, these findings underscored the potential usefulness of a biomarker-based approach for HF [heart failure] risk stratification and allocation of HF prevention therapies among patients with dysglycemia,” the authors wrote. They noted that sodium-glucose cotransporter-2 (SGLT-2) inhibitors are an example of a therapy that might need to be carefully allocated due to cost. Using previously reported relative risk reductions for heart failure events with SGLT-2 inhibitors, the authors estimated that the number of heart failure events that could potentially be prevented with an SGLT-2 inhibitor ranged from 4 per 1,000 patients with a zero score treated for five years to 44 per 1,000 of those with a score of three or four.