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Canadian Journal of Cardiology

Novel Biomarkers for Predicting Cardiovascular Disease in Patients With Diabetes

  • Ravi Retnakaran
    Correspondence
    Corresponding author: Dr Ravi Retnakaran, University of Toronto, Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, 60 Murray St, Suite L5-025, Mailbox-21, Toronto, Ontario M5T 3L9, Canada. Tel.: +1-416-586-4800 ×3941; fax: +1-416-586-8853.
    Affiliations
    Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada

    Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada

    Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
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Published:October 30, 2017DOI:https://doi.org/10.1016/j.cjca.2017.10.017

      Abstract

      It is generally acknowledged that patients with diabetes comprise a high-risk population for the development of cardiovascular disease. However, it is perhaps less well recognized that there actually exists considerable heterogeneity in vascular risk within this patient population, with a sizable subset of individuals seemingly at low risk for major cardiovascular events despite the presence of diabetes. Because traditional clinical risk calculators have shown wide variability in their performance in the setting of diabetes, there exists a need for additional risk predictors in this patient population. In this context, there has been considerable interest in the potential utility of circulating biomarkers as clinical tools that might facilitate risk stratification and thereby guide therapeutic and preventative decision-making. Coupled with the current era of dedicated cardiovascular outcome trials in type 2 diabetes, this interest has spawned a growing literature of recent studies that evaluated potential biomarkers. To date, these studies have identified N-terminal pro-B-type natriuretic peptide, high-sensitivity cardiac troponins, and growth differentiation factor-15 as cardiovascular biomarkers of particular potential in patients with diabetes. Furthermore, recognizing the potential benefit of collective consideration of different biomarkers reflecting distinct pathophysiologic processes that might contribute to the development of cardiovascular disease, there is emerging emphasis on the evaluation of combinations of biomarkers for optimal risk prediction. Although not currently ready for clinical practice, this rapidly-growing topic of biomarker research might ultimately facilitate the goal of individualized risk stratification and thereby enable truly personalized management of diabetes.

      Résumé

      Il est généralement admis que les patients atteints de diabète forment une population exposée à un risque élevé de maladie cardiovasculaire. Cependant, on sait peut-être moins que le risque vasculaire varie énormément au sein de cette population et qu’un sous-groupe appréciable de personnes semble exposé à un faible risque d’événements cardiovasculaires majeurs malgré la présence du diabète. Étant donné que les méthodes de calcul traditionnelles sont d’une efficacité très variable pour évaluer les risques cliniques en présence du diabète, il faut établir d’autres méthodes pour prédire les risques au sein de cette population de patients. Dans un tel contexte, l’utilité potentielle des biomarqueurs présents dans la circulation en tant qu’outils cliniques pouvant faciliter la stratification du risque et, par conséquent, orienter la prise de décision au chapitre du traitement et de la prévention soulève beaucoup d’intérêt. Associé au contexte actuel des essais sur les résultats cardiovasculaires dédiés au diabète de type 2, cet intérêt a engendré de plus en plus de publications d’études récentes visant à évaluer des biomarqueurs potentiels. Jusqu’à maintenant, ces études ont permis de définir le propeptide natriurétique de type B N-Terminal (NT-proBNP), les troponines cardiaques hautement sensibles et le facteur de différenciation de la croissance 15 comme des biomarqueurs cardiovasculaires ayant un potentiel particulier chez les patients atteints de diabète. De plus, en raison des bienfaits possibles liés à la prise en considération commune des différents biomarqueurs qui reflètent les processus physiopathologiques distincts pouvant contribuer à l’apparition de maladies cardiovasculaires, l’accent est de plus en plus mis sur l’évaluation des différents biomarqueurs combinés pour prédire les risques de façon optimale. Bien qu’il ne soit pas encore prêt pour la pratique clinique, ce sujet de recherche sur les biomarqueurs de plus en plus étudié pourrait faciliter la stratification individualisée des risques et ainsi permettre une prise en charge vraiment personnalisée du diabète.
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