Blood test can tell you more than just glucose levels
American Heart Association
A simple blood test may predict the risk of progressive
heart and kidney disease in people with Type 2 diabetes and kidney disease,
according to new research published today in the American Heart Association's
flagship journal Circulation.
copyright American Heart Association
"High levels of certain biomarkers are indicators of heart and kidney complications and may help predict future risk of disease progression," said lead author James Januzzi, M.D., the Hutter Family Professor of Medicine at Harvard Medical School, a cardiologist at the Massachusetts General Hospital and the director of heart failure and biomarker trials at the Baim Institute for Clinical Research in Boston.
"Treatment
with canagliflozin, a sodium glucose co-transporter 2 inhibitor, lowered
biomarker levels and reduced the risk of hospitalization for heart failure and
other heart complications in people at the highest risk."
Health professionals regularly measure biomarkers to
screen, diagnose or treat specific conditions. Previous research has shown that
concentrations of some biomarkers may predict the onset and progression of
chronic kidney disease as well as cardiovascular events in people with Type 2
diabetes.
The researchers analyzed biomarker data from the blood samples of 2,627 people who participated in the Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) trial to assess the effects of canagliflozin on concentrations of the four biomarkers from the study start, the one-year mark and the three-year mark.
They also
examined the prognostic value of each biomarker on various levels of kidney
problems, and risk of death due to kidney disease or cardiovascular disease.
Patients were separated into low, medium and high risk categories. People at
highest risk showed dramatically higher rates of progressive kidney failure and
cardiovascular complications throughout the three-year study period.
The analysis found:
High concentrations of each biomarker at the beginning of
the study were strongly predictive of the severity of the participant's heart
and kidney issues.
The concentrations of each of the four biomarkers in
people taking canagliflozin were lower after one year and three years compared
to those taking the placebo.
After one year, the levels of all biomarkers in
participants who took canagliflozin rose 3% to 10%, compared to an increase of
6% to 29% in the those who took the placebo.
"It was reassuring to discover that canagliflozin helped reduce risks the most in people with the highest chances for complications. Future studies are needed to better understand how Type 2 diabetes in conjunction with kidney disease develops and progresses so that we may initiate life-saving therapies earlier, before symptoms of heart and kidney disease have occurred."
Januzzi said. "Given that the American Heart
Association/American College of Cardiology and the American Diabetes
Association now all recommend measurement of biomarkers to enhance ability to
predict risk in persons with Type 2 diabetes, these results may considerably
extend the reach of biomarker-based testing, refining accuracy even
further."
The study was limited in that not all study participants in the CREDENCE trial had available samples for biomarker measurement, and the participants with biomarker measurement may not be representative of the study's entire population.
Additionally, biomarker data over time were not
complete, and some study participants had missing values during the study
follow-up period. While prognostic thresholds for predicting the risk of kidney
and heart complications in people with Type 2 diabetes have been identified for
two of the biomarkers, prognostic thresholds remain exploratory for the other
two.
Background:
The CREDENCE trial (2014-2018) compared the effectiveness
of a placebo to 100 mg of canagliflozin, which is used to treat Type 2
diabetes. It works in the kidneys to prevent the absorption of glucose. People
enrolled in the phase 3 clinical trial had Type 2 diabetes and chronic kidney
disease; the trial concluded canagliflozin was more effective than placebo in
reducing cardiovascular disease and kidney failure in the participants.
The four biomarkers analyzed in the study were: N-terminal pro-B-type natriuretic peptide; high-sensitivity cardiac troponin T; growth differentiation factor-15; and insulin-like growth factor binding protein 7.