INVESTIGATING THE INTERPLAY OF TYPE 2 DIABETES MELLITUS AND CARDIAC BIOMARKERS IN CARDIOVASCULAR RISK: A CROSS-SECTIONAL RETROSPECTIVE STUDY IN KWAZULU-NATAL.
DOI:
https://doi.org/10.51168/sjhrafrica.v6i6.1683Keywords:
Type 2 Diabetes Mellitus (T2DM), Glycaemic Control, Hba1c, Cardiac Biomarkers, High-Sensitivity Troponin-T, NT-Probnp, Myocardial InjuryAbstract
Objective
This cross-sectional study investigates the relationship between glycaemic control, as indicated by HbA1c levels, and cardiovascular risk biomarkers (high-sensitivity troponin-T, troponin-I, and NT-ProBNP) in patients with Type 2 Diabetes Mellitus (T2DM). T2DM is associated with an increased risk of cardiovascular complications, including heart failure and myocardial infarction, and poor glycaemic control exacerbates these risks.
Methods
A cross-sectional study was conducted at a tertiary hospital in KwaZulu-Natal, including data from 230 patients diagnosed with T2DM. The study analyzed the correlation between HbA1c levels and cardiac biomarkers across different age groups. Demographic data, such as age and gender, were also collected to assess their influence on the relationship between glycaemic control and cardiovascular risk.
Results
The study found a significant positive correlation between elevated HbA1c levels and high-sensitivity troponin-T (ρ = 0.250, p < 0.001), indicating an increased risk of myocardial injury. Older participants exhibited higher NT-ProBNP levels (ρ = 0.116, p = 0.040), suggesting a higher risk of heart failure in this group. Additionally, higher HbA1c levels were associated with higher troponin-I levels, reinforcing the connection between poor glycaemic control and myocardial injury.
Conclusion
This study highlights the critical role of managing glycaemic control to reduce cardiovascular risk in T2DM patients, particularly in older individuals. Regular monitoring of both HbA1c and cardiac biomarkers is essential for early detection and intervention. Further research is needed to explore the combined effects of glycaemic control, comorbidities, and treatments on cardiovascular risk biomarkers.
References
Carlson S, Duber HC, Achan J, Ikilezi G, Mokdad AH, Stergachis A, Wollum A, Bukhman G, Roth GA. Capacity for diagnosis and treatment of heart failure in sub-Saharan Africa. Heart. 2017 Dec 1;103(23):1874-9. https://doi.org/10.1136/heartjnl-2016-310913
Agbor VN, Essouma M, Ntusi NA, Nyaga UF, Bigna JJ, Noubiap JJ. Heart failure in sub-Saharan Africa: a contemporaneous systematic review and meta-analysis. International journal of cardiology. 2018 Apr 15;257:207-15. https://doi.org/10.1016/j.ijcard.2017.12.048
Wang J, Tan GJ, Han LN, Bai YY, He M, Liu HB. Novel biomarkers for cardiovascular risk prediction. Journal of geriatric cardiology: JGC. 2017 Feb;14(2):135.
Katsioupa, M., Kourampi, I., Oikonomou, E., Tsigkou, V., Theofilis, P., Charalambous, G., Marinos, G., Gialamas, I., Zisimos, K., Anastasiou, A. and Katsianos, E., 2023. Novel Biomarkers and Their Role in the Diagnosis and Prognosis of Acute Coronary Syndrome. Life, 13(10),p.1992. https://doi.org/10.3390/life13101992
Grundlingh N, Zewotir TT, Roberts DJ, Manda S. Assessment of prevalence and risk factors of diabetes and pre-diabetes in South Africa. Journal of Health, Population and Nutrition. 2022Mar2;41(1):7. https://doi.org/10.1186/s41043-022-00281-2
Ma CX, Ma XN, Guan CH, Li YD, Mauricio D, Fu SB. Cardiovascular disease in type 2 diabetes mellitus: progress toward personalized management. Cardiovascular diabetology. 2022 May14;21(1):74. https://doi.org/10.1186/s12933-022-01516-6
Demarchi A, Cornara S, Somaschini A, Fortuni F, Mandurino-Mirizzi A, Crimi G, Ferlini M, Gnecchi M, De Servi S, Visconti LO, De Ferrari GM. Has hyperglycemia a different prognostic role in STEMI patients with or without diabetes? Nutrition, Metabolism and Cardiovascular Diseases.2021Feb8;31(2):528-31. https://doi.org/10.1016/j.numecd.2020.09.005
Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, Barengo NC, Beaton AZ, Benjamin EJ, Benziger CP, Bonny A. Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study. Journal of the American college of cardiology. 2020 Dec 22;76(25):2982-3021.
Atlas ID. IDF diabetes atlas reports [Internet]. 2023
Liu HH, Cao YX, Jin JL, Guo YL, Zhu CG, Wu NQ, Gao Y, Zhang Y, Xu RX, Dong Q, Li JJ. Prognostic value of NT-proBNP in patients with chronic coronary syndrome and normal left ventricular systolic function according to glucose status: a prospective cohort study. Cardiovascular Diabetology. 2021 Apr 22;20(1):84. https://doi.org/10.1186/s12933-021-01271-0
Durham AL, Speer MY, Scatena M, Giachelli CM, Shanahan CM. Role of smooth muscle cells in vascular calcification: implications in atherosclerosis and arterial stiffness. Cardiovascular research. 2018 Mar 15;114(4):590-600. https://doi.org/10.1093/cvr/cvy010
Sarhene M, Wang Y, Wei J, Huang Y, Li M, Li L, Acheampong E, Zhengcan Z, Xiaoyan Q, Yunsheng X, Jingyuan M. Biomarkers in heart failure: the past, current and future. Heart failure reviews.2019Nov;24:867-903. https://doi.org/10.1007/s10741-019-09807-z
Motala AA, Mbanya JC, Ramaiya K, Pirie FJ, Ekoru K. Type 2 diabetes mellitus in sub-Saharan Africa: challenges and opportunities. Nature Reviews Endocrinology. 2022 Apr;18(4):219-29. https://doi.org/10.1038/s41574-021-00613-y
Park JM, Lee HS, Park JY, Jung DH, Lee JW. White blood cell count as a predictor of incident type 2 diabetes mellitus among non-obese adults: a longitudinal 10-year analysis of the Korean genome and epidemiology study. Journal of Inflammation Research. 2021 Apr 1:1235-42. https://doi.org/10.2147/JIR.S300026
Sahadew N, Singaram VS, Brown S. Distribution, incidence, prevalence and default of patients with diabetes mellitus accessing public healthcare in the 11 districts of KwaZulu-Natal, South Africa. South African Medical Journal.2016;106(4):389-93. https://doi.org/10.7196/SAMJ.2016.v106i4.10143
Prakaschandra DR, Esterhuizen TM, Motala AA, Gathiram P, Naidoo DP. High prevalence of cardiovascular risk factors in Durban South African Indians: The Phoenix lifestyle project. South African Medical Journal. 2016 Mar 14;106(3):284-9. https://doi.org/10.7196/SAMJ.2016.v106i3.9837
Gaede B, Versteeg M. The state of the right to health in rural South Africa. South African health review. 2011 Jan 1;2011(1):99-106.
Mburu G, George G. Determining the efficacy of national strategies aimed at addressing the challenges facing health personnel working in rural areas in KwaZulu-Natal, South Africa. African Journal of Primary Health Care and Family Medicine. 2017 Feb 22;9(1):1-8. https://doi.org/10.4102/phcfm.v9i1.1355
Thembane N, Madlala M. A RETROSPECTIVE STUDY EVALUATING GLYCAEMIC CONTROL AND LIPID PROFILES IN DIABETIC PATIENTS FROM KWAZULU-NATAL, SOUTH AFRICA. Student's Journal of Health Research Africa. 2023 Jun 29;4(6):13-.
Benalia M, Zeller M, Mouhat B, Guenancia C, Yameogo V, Greco C, Yao H, Maza M, Vergès B, Cottin Y. Glycaemic variability is associated with severity of coronary artery disease in patients with poorly controlled type 2 diabetes and acute myocardial infarction. Diabetes & Metabolism. 2019 Oct 1;45(5):446-52. https://doi.org/10.1016/j.diabet.2019.01.012
Sharma A, Mittal S, Aggarwal R, Chauhan MK. Diabetes and cardiovascular disease: inter-relation of risk factors and treatment. Future Journal of Pharmaceutical Sciences. 2020 Dec;6:1-9. https://doi.org/10.1186/s43094-020-00151-w
American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2021. Diabetescare.2021Jan 1;44(Supplement_1):S15-33. https://doi.org/10.2337/dc21-S002
Herder C, Karakas M, Koenig W. Biomarkers for the prediction of type 2 diabetes and cardiovascular disease. Clinical Pharmacology & Therapeutics. 2011 Jul;90(1):52-66. https://doi.org/10.1038/clpt.2011.93
Alzaabi MA, Abdelsalam A, Alhammadi M, Hani HB, Almheiri A, Al Matrooshi N, Al Zaman K. Evaluating biomarkers as tools for early detection and prognosis of heart failure: A comprehensive review. Cardiac Failure Review. 2024 Jun 3;10:e06. https://doi.org/10.15420/cfr.2023.24
Giardinelli S, Meliota G, Mentino D, D'Amato G, Faienza MF. Molecular Basis of Cardiomyopathies in Type 2 Diabetes. International Journal of Molecular Sciences. 2024Jul29;25(15):8280. https://doi.org/10.3390/ijms25158280
Jesinkey SR, Madiraju AK, Alves TC, Yarborough OH, Cardone RL, Zhao X, Parsaei Y, Nasiri AR, Butrico G, Liu X, Molina AJ. Mitochondrial GTP links nutrient sensing to β cell health, mitochondrial morphology, and insulin secretion independent of OxPhos. Cell reports. 2019 Jul 16;28(3):759-72. https://doi.org/10.1016/j.celrep.2019.06.058
Andrea di A, Bellia A, Di Daniele N, Meloni M, Lauro R, Della-Morte D, Lauro D. The molecular link between oxidative stress, insulin resistance, and type 2 diabetes: A target for new therapies against cardiovascular diseases. Current opinion in pharmacology. 2022 Feb 1;62:85-96. https://doi.org/10.1016/j.coph.2021.11.010
Otamas A, Grant PJ, Ajjan RA. Diabetes and atherothrombosis: The circadian rhythm and role of melatonin in vascular protection. Diabetes and Vascular Disease Research. 2020 Jun;17(3):1479164120920582. https://doi.org/10.1177/1479164120920582
Wolosowicz M, Prokopiuk S, Kaminski TW. Recent advances in the treatment of insulin resistance targeting molecular and metabolic pathways: fighting a losing battle? Medicina. 2022Mar25;58(4):472. https://doi.org/10.3390/medicina58040472
Castiglione V, Aimo A, Vergaro G, Saccaro L, Passino C, Emdin M. Biomarkers for the diagnosis and management of heart failure. Heart failure reviews. 2022 Mar 14:1-9. https://doi.org/10.15420/cfr.2022.23
Fringe FI, Sitar-Taut AV, Caloian B, Zdrenghea D, Comsa D, Gusetu G, Pop D. The role of NT pro-BNP in the evaluation of diabetic patients with heart failure. Acta Endocrinologica (Bucharest). 2020 Apr;16(2):183. https://doi.org/10.4183/aeb.2020.183
Malachias MV, Jhund PS, Claggett BL, Wijkman MO, Bentley‐Lewis R, Chaturvedi N, Desai AS, Haffner SM, Parving HH, Prescott MF, Solomon SD. NT‐proBNP by itself predicts death and cardiovascular events in high‐risk patients with type 2 diabetes mellitus. Journal of the American Heart Association. 2020 Oct 6;9(19):e017462. https://doi.org/10.1161/JAHA.120.017462
Esdaile H, Hill N, Mayet J, Oliver N. Glycaemic control in people with diabetes following acute myocardial infarction. Diabetes research and clinical practice. 2023 May 1;199:110644. https://doi.org/10.1016/j.diabres.2023.110644
Zheng F, Yan L, Yang Z, Zhong B, Xie W. HbA1c, diabetes, and cognitive decline: the English Longitudinal Study of Ageing. Diabetologia. 2018 Apr;61(4):839-48. https://doi.org/10.1007/s00125-017-4541-7
Rawlings AM, Sharrett AR, Albert MS, Coresh J, Windham BG, Power MC, Knopman DS, Walker K, Burgard S, Mosley TH, Gottesman RF. The association of late-life diabetes status and hyperglycemia with incident mild cognitive impairment and dementia: the ARIC study. Diabetes Care. 2019 Jul 1;42(7):1248-54. https://doi.org/10.2337/dc19-0120
Lee YY, Sriram B, Wang SF, Kogularasu S, Chang-Chien GP. Advanced nanomaterial-based biosensors for N-terminal pro-brain natriuretic peptide biomarker detection: progress and future challenges in cardiovascular disease diagnostics. Nanomaterials. 2024 Jan 10;14(2):153.https://doi.org/10.3390/nano14020153
Raseema AK, GEETHA P, Krishnan NR, Chacko AM, Ashraf KM. High Sensitivity Cardiac Troponin-T STAT in Type 2 Diabetes Mellitus Patients and Healthy Individuals: A Comparative Study. Journal of Clinical & Diagnostic Research. 2023 Aug 1;17(8). https://doi.org/10.7860/JCDR/2023/65846.18260
Šimić S, Svaguša T, Prkačin I, Bulum T. Relationship between hemoglobin A1c and serum troponin in patients with diabetes and cardiovascular events. Journal of Diabetes & Metabolic Disorders. 2019 Dec;18:693-704. https://doi.org/10.1007/s40200-019-00460-9
Longo M, Scappaticcio L, Cirillo P, Maio A, Carotenuto R, Maiorino MI, Bellastella G, Esposito K. Glycemic control and the heart: the tale of diabetic cardiomyopathy continues. Biomolecules. 2022 Feb 8;12(2):272. https://doi.org/10.3390/biom12020272
Forman DE, de Lemos JA, Shaw LJ, Reuben DB, Lyubarova R, Peterson ED, Spertus JA, Zieman S, Salive ME, Rich MW, Geriatric Cardiology Section Leadership Council. Cardiovascular biomarkers and imaging in older adults: JACC council perspectives. Journal of the American College of Cardiology. 2020 Sep 29;76(13):1577-94. https://doi.org/10.1016/j.jacc.2020.07.055
Wärja M, Laveborn E, Ott M, Jonsson AP, Stegmayr B. NT-pro-BNP as a marker for a cardiac strain that may be caused by high-output arteriovenous shunting in a hemodialysis patient. A case report. BMC nephrology. 2020 Dec;21:1-6. https://doi.org/10.1186/s12882-020-02195-9
Huang SH, Huang PJ, Li JY, Su YD, Lu CC, Shih CL. Hemoglobin A1c levels associated with age and gender in Taiwanese adults without prior diagnosis with diabetes. International Journal of Environmental Research and Public Health. 2021 Mar 25;18(7):3390. https://doi.org/10.3390/ijerph18073390
Wiviott SD, Cannon CP, Morrow DA, Murphy SA, Gibson CM, McCabe CH, Sabatine MS, Rifai N, Giugliano RP, DiBattiste PM, Demopoulos LA. Differential expression of cardiac biomarkers by gender in patients with unstable angina/non-ST-elevation myocardial infarction: a TACTICS-TIMI 18 (Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy-Thrombolysis In Myocardial Infarction 18) substudy. Circulation. 2004 Feb 10;109(5):580-6.https://doi.org/10.1161/01.CIR.0000109491.66226.26
Stähli BE, Gebhard C, Yonekawa K, Gebhard CE, Altwegg LA, Von Eckardstein A, Hersberger M, Novopashenny I, Wolters R, Wischnewsky MB, Lüscher TF. Gender-related differences in patients presenting with suspected acute coronary syndromes: clinical presentation, biomarkers, and diagnosis. Cardiology. 2015 Aug13;132(3):18998.https://doi.org/10.1159/000435908
Lau ES, Paniagua SM, Guseh JS, Bhambhani V, Zanni MV, Courchesne P, Lyass A, Larson MG, Levy D, Ho JE. Sex differences in circulating biomarkers of cardiovascular disease. Journal of the American College of Cardiology. 2019 Sep 24;74(12):154353.https://doi.org/10.1016/j.jacc.2019.06.077
Yoshida Y, Chen Z, Li C, Mauvais-Jarvis F. Abstract P162: Sex Differences in Cardiometabolic Biomarkers During Pre-Diabetes. Circulation. 2023 Feb 28;147(Suppl_1):AP162-. https://doi.org/10.1161/circ.147.suppl_1.P162
Rivellese AA, Riccardi G, Vaccaro O. Cardiovascular risk in women with diabetes. Nutrition, Metabolism and Cardiovascular Diseases. 2010 Jul 1;20(6):474-80. https://doi.org/10.1016/j.numecd.2010.01.008
Liu HH, Cao YX, Jin JL, Guo YL, Zhu CG, Wu NQ, Gao Y, Zhang Y, Xu RX, Dong Q, Li JJ. Prognostic value of NT-proBNP in patients with chronic coronary syndrome and normal left ventricular systolic function according to glucose status: a prospective cohort study. Cardiovascular Diabetology. 2021 Apr 22;20(1):84. https://doi.org/10.1186/s12933-021-01271-0
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