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.
Why the study?
Cardiovascular prognosis related to type 2 diabetes may not be adequately captured by comorbid conditions such as obesity and hypertension alone.
Do distinct echocardiographic and biomarker phenotypes predict major adverse cardiovascular events in Black adults with type 2 diabetes?
Cohort (n=529)
No
Do distinct echocardiographic and biomarker phenotypes predict major adverse cardiovascular events in Black adults with type 2 diabetes?
Cohort study reveals distinct cardiac phenotypes predict cardiovascular events in Black adults with type 2 diabetes, highlighting the prognostic impact of subclinical heart damage.
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 &3 - with Cluster 3 being a hypertrophic cluster characterized by highest LV mass, levels of brain natriuretic peptide [BNP] and high-sensitivity cardiac troponin-I [hs-cTnI]). After a median 12.1 years, there were 141 cardiovascular events. Compared to Cluster1, Clusters 3 had an increased risk of cardiovascular disease (hazard ratio [HR] 1.60; 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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Echouffo‐Tcheugui et al. (2022) conducted a cohort in Type 2 diabetes (n=529). Cluster 3 phenotype (high LV mass, high cardiac biomarkers) vs. Cluster 1 phenotype was evaluated on Major adverse cardiovascular events (composite of coronary heart disease, stroke, heart failure, and atrial fibrillation) (HR 1.60, 95% CI 1.08-2.37). 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.
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