Precision prognostics for cardiovascular disease in Type 2 diabetes: a systematic review and meta-analysis

Abrar Ahmad, Lee Ling Lim, Mario Luca Morieri, Claudia Ha ting Tam, Feifei Cheng, Tinashe Chikowore, Monika Dudenhöffer-Pfeifer, Hugo Fitipaldi, Chuiguo Huang, Sarah Kanbour, Sudipa Sarkar, Robert Wilhelm Koivula, Ayesha A. Motala, Sok Cin Tye, Gechang Yu, Yingchai Zhang, Michele Provenzano, Diana Sherifali, Russell J. de Souza, Deirdre Kay TobiasPaul W. Franks, Stephen S. Rich, Robert Wagner, Tina Vilsbøll, Kimberly K. Vesco, Miriam S. Udler, Tiinamaija Tuomi, Arianne Sweeting, Emily K. Sims, Jennifer L. Sherr, Robert K. Semple, Rebecca M. Reynolds, Maria J. Redondo, Leanne M. Redman, Richard E. Pratley, Rodica Pop-Busui, Toni I. Pollin, Wei Perng, Ewan R. Pearson, Ruth J.F. Loos, John J. Nolan, Pål Rasmus Njølstad, Mariam Nakabuye, Mathias Ried-Larsen, Torben Hansen, Marta Guasch-Ferré, Christoffer Clemmensen, Mette K. Andersen, Anne Cathrine B. Thuesen, Jordi Merino, ADA/EASD PMDI

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

11 Citationer (Scopus)

Abstract

Background
Precision medicine has the potential to improve cardiovascular disease (CVD) risk prediction in individuals with Type 2 diabetes (T2D).

Methods
We conducted a systematic review and meta-analysis of longitudinal studies to identify potentially novel prognostic factors that may improve CVD risk prediction in T2D. Out of 9380 studies identified, 416 studies met inclusion criteria. Outcomes were reported for 321 biomarker studies, 48 genetic marker studies, and 47 risk score/model studies.

Results
Out of all evaluated biomarkers, only 13 showed improvement in prediction performance. Results of pooled meta-analyses, non-pooled analyses, and assessments of improvement in prediction performance and risk of bias, yielded the highest predictive utility for N-terminal pro b-type natriuretic peptide (NT-proBNP) (high-evidence), troponin-T (TnT) (moderate-evidence), triglyceride-glucose (TyG) index (moderate-evidence), Genetic Risk Score for Coronary Heart Disease (GRS-CHD) (moderate-evidence); moderate predictive utility for coronary computed tomography angiography (low-evidence), single-photon emission computed tomography (low-evidence), pulse wave velocity (moderate-evidence); and low predictive utility for C-reactive protein (moderate-evidence), coronary artery calcium score (low-evidence), galectin-3 (low-evidence), troponin-I (low-evidence), carotid plaque (low-evidence), and growth differentiation factor-15 (low-evidence). Risk scores showed modest discrimination, with lower performance in populations different from the original development cohort.

Conclusions
Despite high interest in this topic, very few studies conducted rigorous analyses to demonstrate incremental predictive utility beyond established CVD risk factors for T2D. The most promising markers identified were NT-proBNP, TnT, TyG and GRS-CHD, with the highest strength of evidence for NT-proBNP. Further research is needed to determine their clinical utility in risk stratification and management of CVD in T2D.
OriginalsprogEngelsk
Artikelnummer11
TidsskriftCommunications Medicine
Vol/bind4
Udgave nummer1
Antal sider28
ISSN2730-664X
DOI
StatusUdgivet - 2024

Bibliografisk note

Funding Information:
A.A., M.D-P., H.F., M.F.G. acknowledge support from the Swedish Heart-Lung Foundation (20190470), Swedish Research Council (EXODIAB, 2009-1039; 2018-02837), Swedish Foundation for Strategic Research (LUDC-IRC, 15-0067), EU H2020-JTI-lMl2-2015-05 (Grant agreement number 115974 \u2013 BEAt-DKD) to M.F.G. L-L.L. acknowledge UK Medical Research Council Population and Systems Medicine Board (IF048-2022). M.L.M. is supported by Italian Ministry of Health Grant \u201CRicerca Finalizzata 2019\u201D \u2013 GR-2019-12369702. C.H.T.T., C.H, and R.C.W.M. acknowledge support from the Research Grants Council of the Hong Kong Special Administrative Region (CU R4012-18), the Croucher Foundation Senior Medical Research Fellowship, University Grants Committee Research Grants Matching Scheme and Research Committee Postdoctoral Fellowship Scheme of the Chinese University of Hong Kong. F.F.C. acknowledge the Second Affiliated Hospital of Chongqing Medical University (No. 2022cffkyqdj). T.C. is an international training fellow supported by the Wellcome Trust grant (214205/Z/18/Z). R.W.K. was funded by a Novo Nordisk Foundation (NNF18OC0031650) postdoctoral fellowship. G.Y. and R.C.W.M. acknowledges support from the Provost\u2019s Scheme for PhD scholarship from the Chinese University of Hong Kong. Y.Z. acknowledges a Postgraduate Studentship and Vice-Chancellor\u2019s PhD scholarship from the Chinese University of Hong Kong. The authors wish to acknowledge the support of librarians from Lund University, Maria Bj\u00F6rklund and Krister Aronsson for their expert support with the literature search. N.M. is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK125780, R01DK134955).

Publisher Copyright:
© The Author(s) 2024.

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