In diabetics, heart failure is detected via a simple blood test

In France, approximately one million people suffer from heart failure. This chronic disease is the leading cause of hospitalization for people over 65. In diabetic patients at cardiovascular risk, early detection is now possible thanks to a blood test that measures a specific protein called NT-proBNP.

Secreted by the heart, NT-proBNP is a protein whose level increases in cases of heart failure. A simple blood test is all that is needed to measure it. In routine practice, the value of this test is significant. A high NT-proBNP level, for example, in cases of suspected acute heart failure, can help the emergency physician focus on a cardiac rather than a pulmonary cause for more specific treatment. “The NT-proBNP biomarker has been used for many years in the diagnosis and monitoring of heart failure patients.” Since 2020, this Roche Diagnostics test has a new indication: it can be used to help assess cardiovascular risk in asymptomatic patients with type 2 diabetes (T2D) who are at high risk of developing cardiovascular disease (poorly controlled diabetes, patients with comorbidities such as hypertension, obesity, kidney disease, cancer, etc.),” explains Laura Lallé, Marketing Manager (Cardiovascular Biomarkers) at Roche Diagnostics.

A DIAGNOSTIC AID

Diabetic patients are twice as likely to develop heart failure as non-diabetics. However, people living with T2D often have few clinical signs suggesting a risk of developing this chronic disease, or these signs may not be specific. A blood test measuring NT-proBNP can predict the risk of developing heart failure in these patients. “An NT-proBNP level below 125 pg/ml has a very good negative predictive value. A level above A level of 125 pg/ml should prompt the patient to consult a cardiologist to confirm the suspicion of heart failure,” says Laura Lallé. Indeed, the NT-proBNP biomarker is a diagnostic aid: it must be supplemented by additional tests such as an electrocardiogram (ECG), chest X-ray, and echocardiogram.

SCREENING FOR BETTER TREATMENT

Heart failure is an increasingly common condition in people with type 2 diabetes: unlike other cardiovascular events, its frequency has not decreased in recent years. “We have wanted to screen for this deadly chronic disease in diabetics for many years. But until now, we didn’t do so because in the event of a positive screening result, we didn’t have a therapeutic strategy for patients,” states Professor Michel Galinier, head of the cardiology department at Toulouse University Hospital.

Today, the situation has changed. New molecules, initially developed for their hypoglycemic properties—the inhibitors of SGLT2 inhibitors have demonstrated benefits in reducing the risk of hospitalization for heart failure. Diabetologists and cardiologists have been using them for about two years. “Investigating the risk of heart failure in a person living with type 2 diabetes is relevant and beneficial, especially since therapeutic solutions to protect against heart failure exist. This cardioprotection is also effective from the start of treatment,” assures Professor Emmanuel Cosson, head of the endocrinology, diabetology, and nutrition department at Avicenne Hospital (Bobigny) and Jean Verdier Hospital (Bondy).

A BIOMARKER UNDERUSED BY SPECIALISTS

NT-proBNP also has predictive value for cardiovascular events in a broader sense. It is not only used to screen for heart failure. “In the presence of an abnormally high NT-proBNP level, vigilance is therefore necessary; one should not focus solely on the risk of heart failure. All types of cardiovascular pathologies must be investigated,” he explains. Professor Cosson. A very useful and inexpensive tool, the NT-proBNP protein assay remains little known and underutilized by diabetologists and cardiologists. Training and information campaigns are needed to raise awareness of the importance of using this test. “In the future, we will need to better organize heart failure screening in diabetics. Otherwise, diabetes will become the leading cause of heart failure, particularly due to the increasing prevalence of obesity worldwide,” concludes Professor Galinier.

Hélia Hakimi-Prévot