NT-proBNP serves as a cardiovascular event and biomarker of death in post-ACS diabetic patients

Results from the Evaluating Lixisenatide in Acute Coronary Syndrome (ELIXA) trial showed that protein biomarkers, including NT-proBNP, can independently predict cardiovascular outcomes in patients with post-acute coronary syndrome type 2 diabetes ( SCA).

ELIXA data, presented in a late-breaking session at the 2022 American Diabetes Association (ADA) Scientific Sessions by Dr. Hertzel Gerstein, Professor of Medicine at McMaster University, showed that an increase in NT -proBNP was associated with a 54% increased risk of major disease. adverse cardiovascular events (MACE) by standard deviation in patients with type 2 diabetes after ACS (relative risk [HR], 1.54; 95% CI, 1.41 – 1.68). The increased biomarker was also associated with a two-fold increased risk of death by one standard deviation in the same patients (HR, 2.01; 95% CI, 1.78, 2.29).

In an interview with HCP Live at ADA 2022, Gerstein discussed the impact of ELIXA’s new findings regarding cardiovascular risk assessment in patients with type 2 diabetes.

HCP Live: What is the understood risk of cardiovascular outcomes and mortality in patients with type 2 diabetes and ACS? What is its burden, compared to other high-risk cardiometabolic patient populations?

Gerstein: Diabetes is an independent risk factor for cardiovascular events. Regardless of their health status, people with diabetes are 1.5 to 3 times more likely to have a cardiovascular event than people without diabetes.

Could you provide a brief history of the proteins identified in the assay?

The ELIXA biomarker study showed 2 things:

  • It provides further validation for a previously validated panel of 10 protein biomarkers for cardiovascular outcomes and 15 for death in people with diabetes. The extent to which these are causally linked to cardiovascular disease or are markers of higher risk due to a link with other causal factors remains unclear.
  • It shows that in people with diabetes and a history of ACS, the addition of a single protein, NT-proBNP, to routinely measured clinical risk factors differentiates those who will or will not develop a cardiovascular event to an extent similar to that of NT-proBNP as well as other proteins. This supports the routine measurement of NT-proBNP in people with type 2 diabetes as a prognostic marker for cardiovascular events and death.

What is the current value of NT-proBNP in assessing the risk of cardiovascular event or disease in patients? What is the status of its evaluation in clinical practice? Are we using it enough?

NT-proBNP is typically used as part of the evaluation of heart failure. The ELIXA biomarker study and other biomarker studies show that its prognostic utility extends to cardiovascular events and death.

What other research on biomarkers of cardiovascular outcomes is your team looking at based on these findings?

Once the biomarkers are identified, it is important to determine which are causal and which are not, which can lead to therapeutic insights.

The study, “Cardiovascular Outcomes in People with Type 2 Diabetes and Acute Coronary Syndrome—The ELIXA Biomarker Study,” was presented at ADA 2022.

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