Heart Failure and Diabetes Mellitus: Biomarkers in Risk Stratification and Prognostication

Abstract

Heart failure (HF) and type 2 diabetes mellitus (T2DM) have a synergistic effect on cardiovascular (CV) morbidity and mortality in patients with established CV disease (CVD). The aim of this review is to summarize the knowledge regarding the discriminative abilities of conventional and novel biomarkers in T2DM patients with established HF or at higher risk of developing HF. While conventional biomarkers, such as natriuretic peptides and high-sensitivity troponins demonstrate high predictive ability in HF with reduced ejection fraction (HFrEF), this is not the case for HF with preserved ejection fraction (HFpEF). HFpEF is a heterogeneous disease with a high variability of CVD and conventional risk factors including T2DM, hypertension, renal disease, older age, and female sex; therefore, the extrapolation of predictive abilities of traditional biomarkers on this population is constrained. New biomarker-based approaches are disputed to be sufficient for improving risk stratification and the prediction of poor clinical outcomes in patients with HFpEF. Novel biomarkers of biomechanical stress, fibrosis, inflammation, oxidative stress, and collagen turn-over have shown potential benefits in determining prognosis in T2DM patients with HF regardless of natriuretic peptides, but their role in point-to-care and in routine practice requires elucidation in large clinical trials.

Comparative study of Dapagliflozin versus Glimepiride effect on insulin regulated aminopeptidase (IRAP) and interleukin-34 (IL-34) in patient with type 2 diabetes mellitus

“…NT-proBNP are biomarkers that are released from the heart in response to inflammation, hypoxia, or myocardial stretching. They have been proved to be a useful marker for the prediction of the development of heart failure in patients with type 2 diabetes 15 . We found that Both drugs have significantly improved the level of NT-proBNP, these findings are contradicting with Kusunose et al, whose findings showed that the level of NT-proBNP was elevated with glimepiride, and are in accordance with Jariwala et al, whose findings have showed that NT-proBNP level is significantly reduced and improved with dapagliflozin.…”

“…Serum level of NP is used as a diagnostic tool for heart failure (HF) development and risk of cardiovascular death, as their serum level increase with the development of heart failure. NP have markedly used in the prediction of incident HF and total cardiovascular events in patients with type 2 diabetes 15 . The ADVANCE trial has shown that NT-proBNP levels are powerful prediction tools for the risk of HF, and death from cardiovascular events in patients with type 2 diabetes mellitus 16 .…”

“…Although, until now, there is no recommendation by guidelines, NP have shown to be very powerful diagnostic and predictive tool for patients with type 2 diabetes mellitus to predict the risk of heart failure and other cardiovascular events. They can also be used for risk stratification in this population 15 , 17 .…”