Evaluation of Cardiac Biomarkers in Patients with Type 2 Diabetes and Subclinical Atherosclerosis: A Cross-Sectional Study

Abstract

Background: Cardiovascular risk in type 2 diabetes mellitus (T2DM) is heterogeneous, and atherosclerosis may evolve silently for years before clinical events. Circulating cardiac biomarkers—particularly high-sensitivity cardiac troponin I (hs-cTnI) and N-terminal pro–B-type natriuretic peptide (NT-proBNP)—may capture subclinical myocardial injury and wall stress that accompany early atherosclerotic disease. We evaluated associations between cardiac biomarkers and ultrasound-defined subclinical atherosclerosis in adults with T2DM without known atherosclerotic cardiovascular disease.

Methods: We performed a hospital-based cross-sectional study (January 2024–December 2024) enrolling adults with T2DM (age 40–75 years) without known coronary, cerebrovascular, or peripheral arterial disease. Subclinical atherosclerosis was defined as mean carotid intima–media thickness (CIMT) ≥0.90 mm and/or carotid plaque on B-mode ultrasonography. Biomarkers included hs-cTnI, NT-proBNP, and high-sensitivity C-reactive protein (hs-CRP). Associations with CIMT were tested using Spearman correlation and multivariable linear regression; predictors of subclinical atherosclerosis were evaluated using multivariable logistic regression and ROC analysis.

Results: Among 260 participants (mean age 58.9±8.7 years; 44% women), 118 (45.4%) met criteria for subclinical atherosclerosis. Median hs-cTnI and NT-proBNP were higher in the subclinical atherosclerosis group versus controls (hs-cTnI: 6.2 vs 3.8 ng/L; NT-proBNP: 112 vs 78 pg/mL; both p<0.001), while hs-CRP showed a smaller gradient (p=0.04). In adjusted models, log-hs-cTnI (adjusted OR 1.78, 95% CI 1.27–2.48) and log-NT-proBNP (adjusted OR 1.52, 95% CI 1.12–2.07) independently predicted subclinical atherosclerosis. A combined biomarker model improved discrimination (AUC 0.82) over clinical risk factors alone (AUC 0.73).

Conclusion: In T2DM without known ASCVD, hs-cTnI and NT-proBNP were independently associated with ultrasound-defined subclinical atherosclerosis and improved risk discrimination. Biomarker-informed vascular phenotyping may support earlier identification of high-risk diabetic patients for intensified prevention strategies.