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

ADA/EASD PMDI

doi:10.1038/s43856-023-00429-z

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

ADA/EASD PMDI

Research output: Contribution to journal › Article › peer-review

16 Scopus citations

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.

Original language	English (US)
Article number	11
Journal	Communications Medicine
Volume	4
Issue number	1
DOIs	https://doi.org/10.1038/s43856-023-00429-z
State	Published - Dec 2024

Funding

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).

ASJC Scopus subject areas

Public Health, Environmental and Occupational Health
Internal Medicine
Epidemiology
Medicine (miscellaneous)
Assessment and Diagnosis

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1038/s43856-023-00429-z

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

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.",

author = "{ADA/EASD PMDI} and Abrar Ahmad and Lim, {Lee Ling} and Morieri, {Mario Luca} and Tam, {Claudia Ha ting} and Feifei Cheng and Tinashe Chikowore and Monika Dudenh{\"o}ffer-Pfeifer and Hugo Fitipaldi and Chuiguo Huang and Sarah Kanbour and Sudipa Sarkar and Koivula, {Robert Wilhelm} and Motala, {Ayesha A.} and Tye, {Sok Cin} and Gechang Yu and Yingchai Zhang and Michele Provenzano and Diana Sherifali and {de Souza}, {Russell J.} and Tobias, {Deirdre Kay} and Franks, {Paul W.} and Rich, {Stephen S.} and Robert Wagner and Tina Vilsb{\o}ll and Vesco, {Kimberly K.} and Udler, {Miriam S.} and Tiinamaija Tuomi and Arianne Sweeting and Sims, {Emily K.} and Sherr, {Jennifer L.} and Semple, {Robert K.} and Reynolds, {Rebecca M.} and Redondo, {Maria J.} and Redman, {Leanne M.} and Pratley, {Richard E.} and Rodica Pop-Busui and Pollin, {Toni I.} and Wei Perng and Pearson, {Ewan R.} and Ozanne, {Susan E.} and Owen, {Katharine R.} and Richard Oram and Rinki Murphy and Viswanathan Mohan and Shivani Misra and Meigs, {James B.} and Nestoras Mathioudakis and Josefson, {Jami L.} and Scholtens, {Denise M.} and Lowe, {William L.}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2024.",

year = "2024",

month = dec,

doi = "10.1038/s43856-023-00429-z",

language = "English (US)",

volume = "4",

journal = "Communications Medicine",

issn = "2730-664X",

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number = "1",

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TY - JOUR

T1 - Precision prognostics for cardiovascular disease in Type 2 diabetes

T2 - a systematic review and meta-analysis

AU - ADA/EASD PMDI

AU - Ahmad, Abrar

AU - Lim, Lee Ling

AU - Morieri, Mario Luca

AU - Tam, Claudia Ha ting

AU - Cheng, Feifei

AU - Chikowore, Tinashe

AU - Dudenhöffer-Pfeifer, Monika

AU - Fitipaldi, Hugo

AU - Huang, Chuiguo

AU - Kanbour, Sarah

AU - Sarkar, Sudipa

AU - Koivula, Robert Wilhelm

AU - Motala, Ayesha A.

AU - Tye, Sok Cin

AU - Yu, Gechang

AU - Zhang, Yingchai

AU - Provenzano, Michele

AU - Sherifali, Diana

AU - de Souza, Russell J.

AU - Tobias, Deirdre Kay

AU - Franks, Paul W.

AU - Rich, Stephen S.

AU - Wagner, Robert

AU - Vilsbøll, Tina

AU - Vesco, Kimberly K.

AU - Udler, Miriam S.

AU - Tuomi, Tiinamaija

AU - Sweeting, Arianne

AU - Sims, Emily K.

AU - Sherr, Jennifer L.

AU - Semple, Robert K.

AU - Reynolds, Rebecca M.

AU - Redondo, Maria J.

AU - Redman, Leanne M.

AU - Pratley, Richard E.

AU - Pop-Busui, Rodica

AU - Pollin, Toni I.

AU - Perng, Wei

AU - Pearson, Ewan R.

AU - Ozanne, Susan E.

AU - Owen, Katharine R.

AU - Oram, Richard

AU - Murphy, Rinki

AU - Mohan, Viswanathan

AU - Misra, Shivani

AU - Meigs, James B.

AU - Mathioudakis, Nestoras

AU - Josefson, Jami L.

AU - Scholtens, Denise M.

AU - Lowe, William L.

PY - 2024/12

Y1 - 2024/12

N2 - 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.

AB - 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.

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U2 - 10.1038/s43856-023-00429-z

DO - 10.1038/s43856-023-00429-z

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ER -

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

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UN SDGs

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