New test finds even diabetics who appear healthy may have heart damage

by Barbara Hewitt on September 17, 2014

People with diabetes who appear otherwise healthy may have a sixfold higher risk of developing heart failure regardless of their cholesterol levels, new research suggests.

Researchers from the Johns Hopkins Bloomberg School of Public Health in the United States used an ultra-sensitive test to identify minute levels of a protein released into the blood when heart cells die.


Cardiovascular disease is the leading cause of death among diabetics

They found the protein in nearly 50% of people with diabetes in their study and said that the finding suggests that people with diabetes may be suffering undetectable but potentially dangerous heart muscle damage, possibly caused by their elevated blood sugar levels.

Cardiovascular disease is the leading cause of death among those with diabetes, and much of that has been blamed on atherosclerosis, or hardening of the arteries. The new research suggests that a large subsection of people with diabetes are at increased risk of heart failure and cardiac death unrelated to the common culprits of cholesterol and atherosclerosis.

‘It puts what we know about heart damage in diabetes on its head. It looks like diabetes may be slowly killing heart muscle in ways we had not thought of before,’ said study leader Elizabeth Selvin, an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health.

She explained that a test for even slightly elevated levels of troponin, the protein released into the blood only when heart cells die, could someday be used to screen for very early chronic heart damage.

Because of the link between cardiovascular disease and diabetes, people with newly diagnosed diabetes are typically prescribed a statin, one of a hugely popular class of cholesterol lowering drugs.

This study, Selvin said, suggests that there may be people with diabetes whose heart risk may have nothing to do with cholesterol. ‘Statin treatment may not be sufficient to prevent damage to the heart in people with diabetes. Even though there may be no symptoms yet, our research suggests there is microvascular damage being done to the heart, which is leading to heart failure and even death,’ she added.

When someone arrives at the hospital with chest pains, a standard blood test is used to check for troponin leaking from heart cells into the blood. Elevated troponin levels suggest a heart attack. But the test Selvin and her colleagues used to look for troponin is 10 times more sensitive and picks up very low levels of the protein, identifying previously undetected subclinical chronic damage to the heart.

For the study, the researchers measured troponin concentrations in more than 9,000 participants in the Atherosclerosis Risk in Communities Study (ARIC) at two time points, six years apart. Those with diabetes were two and a half times more likely to have elevated troponin levels than those without.

Then, the researchers looked at 14 years of follow-up data from ARIC. Diabetics with elevated troponin were six times more likely to develop heart failure and four times more likely to have a heart attack. Those with pre-diabetes, a condition associated with a high risk of progressing to diabetes, were also at increased risk.

More research is needed, Selvin said, to determine the exact mechanism for how diabetes may be causing the heart damage.


The opinions expressed in this article do not necessarily reflect the views of the Community and should not be interpreted as medical advice. Please see your doctor before making any changes to your diabetes management plan.

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