What is the clinical evidence from this study?

Study design: Cohort. Population: Type 2 diabetes (n=529). Intervention: Cluster 3 phenotype (high LV mass, high cardiac biomarkers) vs. Cluster 1 phenotype. Primary outcome: Major adverse cardiovascular events (composite of coronary heart disease, stroke, heart failure, and atrial fibrillation) (HR 1.60, 95% CI 1.08-2.37).

What does this research mean for the field?

Among Black adults with type 2 diabetes, a specific patient phenotype characterized by high left ventricular mass and elevated cardiac biomarkers is associated with a 60% increased risk of major adverse cardiovascular events compared to a baseline phenotype. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 1, 2022Open Access

Patients phenotypes and cardiovascular risk in type 2 diabetes: the Jackson Heart Study

Key Result

Cluster 3 (high left ventricular mass and elevated cardiac biomarkers) increased the risk of cardiovascular events (HR 1.60) compared to Cluster 1 among Black adults with type 2 diabetes.

Study Design

Type

Cohort (n=529)

Multicenter

Structured PICO

Do distinct echocardiographic and biomarker phenotypes predict major adverse cardiovascular events in Black adults with type 2 diabetes?

Population

529 Black adults with type 2 diabetes from the Jackson Heart Study, mean age 60 ± 10 years, 68% women. Excluded: history of cardiovascular disease (including coronary artery disease, cardiomyopathy/heart failure, valvular heart disease, regional LV wall motion abnormalities) and missing echocardiographic or biomarker data.

Intervention

Phenotypic clustering based on clinical, biochemical, and echocardiographic variables (Cluster 3: hypertrophic phenotype characterized by highest LV mass, BNP, and hs-cTnI)

Comparator

Cluster 1 (intermediate phenotype) and Cluster 2 (lowest LV mass, highest LVEF)

Outcome

Major adverse cardiovascular events (MACE - composite of coronary heart disease, stroke, heart failure, and atrial fibrillation) over a median 12.1 years follow-upcomposite

Main Result

Effect estimate: HR 1.60 (95% CI 1.08-2.37)

Absolute Event Rate: 43.93% vs 22.95%

Limitations

Lacked power to investigate individual cardiovascular disease events
Results may not be generalizable to other ethnic groups or Blacks elsewhere in the United States
Did not include all potentially relevant echocardiographic indices such as LA volumes, tissue Doppler, and strain measures
Lacked data on diabetes duration and microvascular complications
Potential selection bias from excluding participants with missing data
Potential residual confounding due to the observational nature of the study

Abstract

BACKGROUND: Cardiovascular prognosis related to type 2 diabetes may not be adequately captured by information on comorbid conditions such as obesity and hypertension. To inform the cardiovascular prognosis among diabetic individuals, we conducted phenotyping using a clustering approach based on clinical data, echocardiographic indices and biomarkers. METHODS: We performed a cluster analysis on clinical, biochemical and echocardiographic variables from 529 Blacks with diabetes in the Jackson Heart Study. An association between identified clusters and major adverse cardiovascular events (MACE- composite of coronary heart disease, stroke, heart failure and atrial fibrillation) was assessed using Cox proportional hazards modeling. RESULTS: Cluster analysis separated individuals with diabetes (68% women, mean age 60 ± 10 years) into three distinct clusters (Clusters 1,2 95% confidence interval CI 1.08, 2.37), while Cluster 2 had a similar risk of outcome (HR 1.11; 95% CI 0.73, 168). CONCLUSIONS: Among Blacks with diabetes, cluster analysis identified three distinct echocardiographic and biomarkers phenotypes, with cluster 3 (high LV mass, high cardiac biomarkers) associated with worse outcomes, thus highlighting the prognostic value of subclinical myocardial dysfunction.

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