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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Article info
Publication history
Published online: October 30, 2017
Accepted:
October 22,
2017
Received:
September 22,
2017
Footnotes
See page 629 for disclosure information.
Identification
Copyright
© 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
