Physicians' Academy for Cardiovascular Education

Simple biomarker-based risk score for prediction of incident HF in (pre-)diabetes

Biomarker-Based Risk Prediction of Incident Heart Failure in Pre-Diabetes and Diabetes

Literature - Pandey A, Vaduganathan M, Patelet KV et al., - JACC Heart Fail. 2020 Dec 24;S2213-1779(20)30591-6. doi: 10.1016/j.jchf.2020.10.013.

Introduction and methods

Patients with diabetes and pre-diabetes are at high risk for HF [1,2]. It has been demonstrated that SGLT2i reduces the risk of HF among patients with diabetes [3]. However, prescription rates remain low among diabetic patients with an indication for an SGLT2i [4]. A risk stratification tool to identify patients with (pre-)diabetes at highest risk for HF could help to allocate SGLT2i to patients who would derive the greatest benefit from treatment. This study evaluated the application of a simple biomarker-based risk score for the stratification of HF risk in patients with diabetes and pre-diabetes.

Data from patients with dysglycemia (n=6,799, 33.2% with diabetes, 66.8% with pre-diabetes) free of CVD were pooled from 3 cohort studies (Atherosclerois Risk in Communities [ARIC], Dallas Heart Study [DHS], and Multi-Ethnic Study of Atherosclerosis [MESA]) [5-7]. Elevated levels of 4 cardiac and inflammatory biomarkers that were associated with higher risk of HF among healthy adults were included in an integer-based risk score: hs-cTnT ≥6 ng/l; NT-proBNP ≥125 pg/ml, hs-CRP ≥3 mg/l, and left ventricular hypertrophy by ECG, with 1 point for each abnormal biomarker [8-11]. Risk of incident HF was assessed in 4 score groups: very low (0, reference group), low (1), intermediate (2), and high (≥3). The primary outcome was incident HF. Median follow-up was 17 years. 5- and 10-year risk of incident HF was calculated for patients with diabetes and pre-diabetes across the 4 risk score groups. In addition, the number of HF events that could be prevented using a SGLT2i per 1000 treated participants over 5 and 10 years was estimated.

Main results


This study showed that a simple integer-based biomarker score could identify patients with (pre-)diabetes who are at an increased risk of incident HF. Risk of incident HF increased with increasing biomarker score group among participants with diabetes and pre-diabetes. The 5-year risk of incident HF among participants with a biomarker score of 0 or 1 was comparable to the risk in participants with euglycemia, while 5-year risk of HF in participants with a high biomarker score was 15-fold (in diabetes) and 10-fold (in pre-diabetes) higher compared with subjects with euglycemia. The estimated numbers of HF events that could be prevented with an SGLT2i for every 1000 subjects with diabetes increased with increasing biomarker score groups.


Show references

Find this article online at JACC Heart Fail.

Share this page with your colleagues and friends: