Early Detection of Heart Failure in Patients with Type 2 Diabetes

Patients with diabetes are prone to heart failure, a condition that, in turn, worsens diabetes and triples the risk of mortality. The NT-proBNP test plays a crucial role in diagnosing, prognosing, and monitoring heart failure, particularly in diabetic patients.

Experts shared these insights during the scientific seminar “Multidimensional Perspectives in Managing Type 2 Diabetes: The Role of Biomarkers” held at Tam Anh General Hospital in Ho Chi Minh City, on the afternoon of August 16.

At the seminar, Dr. Lam Van Hoang, Head of the Endocrinology and Diabetes Department at Tam Anh General Hospital, noted that obesity and diabetes significantly increase the risk of cardiovascular disease. As metabolic disorders, they contribute to atherosclerosis, which leads to coronary artery disease, myocardial ischemia, and heart attacks. Diabetic cardiomyopathy weakens the heart’s pumping function and can result in heart failure. Diabetes also increases the risk of arrhythmias. Moreover, hypertension in diabetic patients exacerbates cardiovascular complications.

Dr. Lam Van Hoang presents on early detection and treatment of heart failure complications in diabetic patients.

Diabetic patients are susceptible to two main groups of complications. Macrovascular complications, which affect large blood vessels, include damage to the coronary arteries, blood vessels in the neck (carotid arteries), which may lead to stroke, lower extremity arteries, and the aorta. Microvascular complications, which affect small blood vessels, include chronic kidney disease, retinal damage, and diabetic neuropathy.

Cardiovascular complications in diabetic patients largely stem from lipid metabolism disorders, leading to elevated blood glucose and insulin resistance.

“Early identification of heart failure risk in diabetic patients by measuring the level of NT-proBNP—a cardiac hormone—in the bloodstream is crucial,” said Dr. Lam Van Hoang. Elevated NT-proBNP levels can be a sign of heart failure or other cardiac issues. Measuring NT-proBNP supports diagnosis, severity assessment, and monitoring the effectiveness of heart failure treatment.

This test is recommended for all patients with type 1 diabetes aged 30 and older, and for all patients with type 2 diabetes at the time of diagnosis, regardless of age.

Numerous healthcare professionals attend the seminar

Further elaborating on the role of the NT-proBNP test in managing heart failure in diabetic patients, Dr. Nguyen Thanh Son, Deputy Head of the Endocrinology and Diabetes Department at Tam Anh General Hospital in Hanoi, emphasized that NT-proBNP is the most powerful predictor of cardiovascular events in diabetic patients—more so than echocardiograms, ECGs, or albumin levels.

“Combined vascular and myocardial damage in diabetic patients leads to heart failure. Diabetes makes patients more vulnerable to heart failure, and heart failure exacerbates diabetes. It’s a vicious cycle,” Dr. Son explained. Heart failure affects more than one in five people with diabetes. Even when risk factors like dyslipidemia and hypertension are well-controlled, type 2 diabetes remains an independent contributor to heart failure, proving that it is a common consequence in diabetic patients.

Heart failure worsens the clinical progression of a diabetic patient, increasing the risk of hospitalization by over 33% and lengthening hospital stays. Type 2 diabetic patients with heart failure face a threefold increase in mortality compared to diabetic patients without heart failure.

Early detection of heart failure through NT-proBNP testing and aggressive treatment can help reduce the risk of developing symptomatic heart failure in diabetic patients.

Dr. Tran Thi Thanh Nga highlights the critical role of NT-proBNP testing in early heart failure detection

According to Dr. Tran Thi Thanh Nga, Director of the Laboratory Center at Tam Anh General Hospital in Ho Chi Minh City, the NT-proBNP test plays a vital role in the early detection, diagnosis, prognosis, and monitoring of heart failure.

In diabetic patients, a significant increase in NT-proBNP levels can be observed as early as six months before hospitalization due to heart failure, regardless of prior history. In clinical practice, NT-proBNP provides valuable prognostic insight and helps to stratify at-risk patients, thereby optimizing the hospital admission and treatment plans.

The clinical utility of NT-proBNP is increasingly recognized. It is now used for early detection of heart failure risk in patients with type 2 diabetes, allowing for more aggressive treatment to prevent complications. A test result of >125 pg/mL is considered a red flag for potential heart failure events in diabetic patients. If NT-proBNP levels exceed this threshold, patients should undergo comprehensive cardiovascular risk assessment and receive early, aggressive treatment with cardioprotective medications to mitigate the risk of heart failure.