Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.
Can J Cardiol. 2018 May;34(5):624-631. doi: 10.1016/j.cjca.2017.10.017. Epub 2017 Oct 31.
It is generally acknowledged that patients with diabetes comprise a high-risk population for the development of cardiovascular disease. However, it is perhaps less well recognized that there actually exists considerable heterogeneity in vascular risk within this patient population, with a sizable subset of individuals seemingly at low risk for major cardiovascular events despite the presence of diabetes. Because traditional clinical risk calculators have shown wide variability in their performance in the setting of diabetes, there exists a need for additional risk predictors in this patient population. In this context, there has been considerable interest in the potential utility of circulating biomarkers as clinical tools that might facilitate risk stratification and thereby guide therapeutic and preventative decision-making. Coupled with the current era of dedicated cardiovascular outcome trials in type 2 diabetes, this interest has spawned a growing literature of recent studies that evaluated potential biomarkers. To date, these studies have identified N-terminal pro-B-type natriuretic peptide, high-sensitivity cardiac troponins, and growth differentiation factor-15 as cardiovascular biomarkers of particular potential in patients with diabetes. Furthermore, recognizing the potential benefit of collective consideration of different biomarkers reflecting distinct pathophysiologic processes that might contribute to the development of cardiovascular disease, there is emerging emphasis on the evaluation of combinations of biomarkers for optimal risk prediction. Although not currently ready for clinical practice, this rapidly-growing topic of biomarker research might ultimately facilitate the goal of individualized risk stratification and thereby enable truly personalized management of diabetes.
人们普遍认为，糖尿病患者是心血管疾病发展的高危人群。然而，人们可能较少认识到，在这个患者群体中，血管风险实际上存在相当大的异质性，尽管存在糖尿病，但相当一部分人似乎患重大心血管事件的风险较低。由于传统的临床风险计算器在糖尿病环境中的表现存在很大差异，因此需要在该患者群体中增加其他风险预测因子。在这种情况下，人们对循环生物标志物作为临床工具的潜在效用产生了极大的兴趣，这些工具可能有助于风险分层，并指导治疗和预防决策。再加上当前 2 型糖尿病专门的心血管结局试验时代，这种兴趣催生了越来越多评估潜在生物标志物的研究文献。迄今为止，这些研究已经确定了 N 末端脑钠肽前体、高敏心肌肌钙蛋白和生长分化因子 15 是糖尿病患者具有特殊潜力的心血管生物标志物。此外，认识到考虑反映可能导致心血管疾病发展的不同病理生理过程的不同生物标志物的综合考虑的潜在益处，人们越来越强调评估生物标志物组合以进行最佳风险预测。尽管目前还不能用于临床实践，但生物标志物研究这一快速发展的课题最终可能有助于实现个体化风险分层的目标，并实现真正的糖尿病个性化管理。
