The genetic risk-assessment tool could help implement more targeted intervention efforts, said lead author Pankaj Arora, MD, associate professor of cardiology at the University of Alabama in Birmingham, in a release. “In the current era of precision medicine, we want to find the individualized approach of understanding the risk of heart disease in a person newly diagnosed with diabetes,” he says. This personalized approach based on genetic risk could allow doctors to focus clinical efforts more effectively, adds Dr. Arora.
People With Type 2 Diabetes at Greater Risk of Heart Attack and Stroke
It’s estimated that between 33 and 35 million people in the United States have type 2 diabetes (T2D), according to the Centers for Disease Control and Prevention (CDC). People with T2D are twice as likely to have heart disease or stroke compared with someone without diabetes — and at a younger age, per the agency. Other factors that are used to assess heart disease risk include blood pressure, cholesterol levels, family history, and smoking status. In this study, researchers explored if genetic risk of high blood pressure may predispose some people with type 2 diabetes to a higher risk of heart attack, stroke or cardiovascular death and if tight control of blood sugar impacts the link between genetic hypertension risk and cardiovascular outcomes.
How the Study Was Conducted
Researchers used the genetic data of 6,335 participants from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial database. The study group consisted of 37 percent women. Participants were asked to self-identify their race or ethnicity; 15 percent identified as Black, 6 percent as Hispanic, 70 percent as white, and 9 percent selected the category “other.” All participants had T2D and elevated blood pressure, and they were followed for 3.5 years. Investigators reviewed multiple health factors, including blood pressure, cholesterol, and blood sugar levels, along with each participant’s age, sex, body mass index, medical history and DNA. They assigned each individual a risk score by comparing his or her DNA to a genetic variant map of more than 1,000 common genetic variants known to affect blood pressure. The more matches among the participant’s DNA and the map of known blood pressure genetic variants, the higher genetic risk score. Researchers found that the genetic risk score identified study participants with a higher risk of cardiovascular events; for people with above average genetic risk scores, each degree higher was associated with a 12 percent higher risk of heart disease or stroke events.
Intensive Blood Sugar Control Didn’t Appear to Influence Risk for Heart Disease
Somewhat surprisingly, when researchers compared participants who were taking medications to manage their blood sugar levels with those who were not, the association of genetic risk with cardiovascular events was the same. It’s not clear from the findings why intensive glycemic control by way of aggressive treatment with insulin, medications, diet and exercise didn’t seem to have a cardiovascular benefit for the participants with long-standing type 2 diabetes, according to the authors. Even so, a genetic risk score maybe helpful for people newly diagnosed with type 2 diabetes to identify who may benefit from ramped up diet and exercise interventions and more aggressive management of weight, blood pressure, and smoking cessation, noted Arora.
Ways of Reducing the Risk of Heart Disease if You Have T2D
“If you have type 2 diabetes, there’s a lot you can do to reduce your risk for heart disease,” said Eduardo Sanchez, MD, MPH, AHA’s chief medical officer for prevention, and clinical lead for Know Diabetes by Heart, a collaborative initiative between the AHA and the American Diabetes Association, in the AHA release. Dr. Sanchez was not involved with this research. Controlling blood sugar control, staying in touch with your doctor, discontinuing all tobacco use and getting at least 150 minutes a week of moderate exercise can all help people with T2D improve their heart health, according to the AHA.
