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Challenging and opportunities in clinical implementation of circulating cardiac biomarkers in diabetes mellitus: the narrative review

Diabetes mellitus (DM) is a powerful factor contributing cardiovascular (CV) morbidity and mortality in general population. The purpose of the narrative review was to summarize the knowledge with respect to clinical perspectives of the implementation of the circulating biomarkers to stratify patients with type 2 DM (T2DM) at higher CV risk. The bibliographic database of life science and biomedical information MEDLINE, EMBASE, Medline (PubMed), the Web of Science, and the Cochrane Central were searched for English publications satisfying the following of key words: [diabetes mellitus], [type 2 diabetes mellitus], [cardiovascular risk], [cardiovascular risk factors], [cardiac biomarkers]; [circulating biomarkers]; [prognosis]. Conventional biomarkers of biomechanical myocardial stress (natriuretic peptides, cardiac high sensitive troponin T and I), fibrosis (soluble suppressor tumorigenicity-2), and inflammation (growth differential factor-15) may assist in the risk stratification and prediction of T2DM-related complications. Novel circulating biomarkers focused on several specific pathological processes accompanying T2DM, such as extracellular matrix remodeling [matrix metalloproteinases (MMPs), collagen turn-over and bone-related proteins], altered vascular reparation [the number and function of the endothelial progenitor cells (EPCs)], and profiling of cell-to-cell cooperation [endothelial cell derived extracellular vesicles (EVs)], continue to be developed and show promise in the prognosis of the T2DM patient. Conventional approach is based on the use of NPs and cardiac troponins in routine clinical practice, whereas there is no evidence that these biomarkers have equal diagnostic and predictive values for patients with prediabetes and established T2DM.