H-FABP and Hs-cTnI Serum Concentrations Associate with the Development of Cardiovascular Events in Newly Diagnosed T2D, Pre-DM, and Normoglycemic Individuals

Background: CVD remains the leading global cause of mortality, especially in individuals with T2D and Pre-DM, where insulin resistance increases cardiometabolic risk and early myocardial injury often goes unrecognized. This study aimed to evaluate baseline serum concentrations of H-FABP and Hs-cTnI, biomarkers linked to myocardial injury, in newly diagnosed T2D, Pre-DM, and normoglycemic individuals, to assess their predictive value for CVEs and the association between H-FABP and HOMA-IR. Methods: In a prospective cohort study of 72 medication-free participants (25 T2D, 22 Pre-DM, 25 normoglycemic) without clinical myocardial symptoms, baseline anthropometric and biochemical measurements were obtained, including H-FABP, Hs-cTnI, HbA1c, fasting glucose, fasting insulin, and HOMA-IR was calculated. Participants were followed one year to evaluate the occurrence of CVE. Results: Strong correlations between baseline H-FABP and Hs-cTnI across all glycemic groups (all p<0.01) with no significant intergroup differences. In abnormal weight T2D participants, baseline fasting insulin correlated moderately with baseline H-FABP (ρ=0.50, p=0.029) and strongly with baseline HOMA-IR (ρ=0.74, p<0.001). CVEs occurred in 33.3% of participants and were associated with elevated baseline H-FABP and Hs-cTnI (p<0.001 and p=0.001), alongside strong biomarker inter-correlation (ρ=0.64 overall; ρ=0.84 in CVEs). Both biomarkers independently predicted CVEs; H-FABP had higher sensitivity and NPV, while Hs-cTnI showed greater specificity and PPV. Glycemic status was not statistically associated with CVE occurrence, although higher HOMA-IR and insulin were observed in the CVE group (p=0.073 and p=0.054). Conclusion: These findings support H-FABP as a cardiac biomarker for myocardial injury across normoglycemic, Pre-DM, and T2D groups. The link between H-FABP and insulin resistance in individuals with greater burden of metabolic disturbance highlights its role as a cardiometabolic indicator. Both biomarkers predicted CVEs in asymptomatic individuals, with H-FABP potentially useful for early risk exclusion and Hs-cTnI for confirming high-risk status.