Diabetes affects nearly 400 million people worldwide and is expected to increase to nearly 600 million people by 2035. Patients with diabetes mellitus are often more susceptible to a host of multi-organ complications that arise as a result of microvascular and macrovascular dysfunction. These complications equate to the leading cause of morbidity and mortality in the form of accelerated atherosclerotic disease.
There are a variety of contributing factors leading to both diabetes and cardiovascular disease including genetics, environment, and lifestyle. However, those with diabetes should be aware of recent research that could significantly affect heart health. In fact, the October 2015 issue of the Journal of American College of Cardiology reports that genetic testing for a specific blood protein might identify individuals with diabetes who are at a greater risk for coronary heart disease. Moreover, those with diabetes and carrying one specific variant might be 1000 percent more likely to suffer a heart attack.
Haptoglobin (Hp) is an acute phase plasma protein with hemoglobin-binding properties that is expressed as either Hp1 or Hp2 alleles. Haptoglobin has the primary task of capturing and eliminating free heme circulating in the blood and tissues. For this reason, Hp is considered a key antioxidant molecule in the prevention of hemoglobin-induced oxidative tissue damage. Each of us carries two copies of the Hp molecule. These are expressed as three potential genotypes: Hp1-1, Hp1-2, and Hp2-2 representing 16, 37 and 47 percent of the U.S. population respectively.
One of the key blood values for any diabetic patient is the hemoglobin A1C value, which represents a person’s approximate blood sugar levels over the past three months. Recent evidence from several groups around the world indicates that if a person carries the Hp1-2 or Hp2-2 gene and has an A1C above 6.5, they have a significantly increased risk for a cardiovascular event.
Diabetes is well established as a risk factor for heart disease. Clinical evidence suggests that 65 percent of diabetic patients will suffer a heart attack, and a significant portion will perish from cardiovascular complications.
Greater than 70 percent of the population carries at least one form of the Hp2 gene. Those with diabetes and the Hp1-2 gene are three times more likely to have a cardiovascular event, while diabetics with the Hp2-2 gene are five times more likely to suffer a cardiovascular event. Therefore, Hp1-2 and Hp2-2 are directly predictive of heart disease in those with diabetes.
The testing for Hp genotype is facilitated by a simple, non-invasive oral rinse that can be administered within minutes, and the assay is both affordable and actionable. The clinical objective with any patient with diabetes is to minimize the risk for a cardiovascular event. The treatment for those with Hp2 is supplemental vitamin E therapy. For those with a single copy of Hp2, the treatment suggestion is 200IU of a high quality vitamin E and 400IU for those with two copies of Hp2. Therapy should not be implemented, however, until a genotype has been determined. In a multiyear study, long-term vitamin E has been shown to increase the risk of a heart attack for those without Hp2 alleles.
Additionally, there are many cases when Hp gene-carriers are found to be vitamin C deficient because vitamin C is utilized as an antioxidant surrogate in place of Hp. Therefore, supplementation of vitamin C might also be beneficial for this group. Excellent sources of vitamin C include oranges, grapefruits, strawberries, bananas, broccoli, spinach, potatoes and tomatoes.
Heart disease is the currently number one and diabetes the number seven cause of death in the United States. According to 2012 data from the American Diabetes Association, there are nearly 30 million Americans suffering from diabetes and more than 85 million with prediabetes. Moreover, Hp2 carriers face risk of developing increased cholesterol levels, increased risk for aneurysms, as well as elevated arterial inflammation — a known contributing factor to having a stroke.
With one simple, non-invasive test, diabetic patients can find out if they are at increased risk of cardiovascular events, and clinicians can take preventive measures to minimize those risks.
If an event does occur, patients who carry the Hp2 gene will require more treatment support and follow-up once out of the hospital than normal patients. In the grand scheme of things, a heart attack could cost insurance companies and patients anywhere from $700,000 to $1 million, according to insurance providers such as Assurant Employee Benefits. Therefore, allocating a few dollars on a genetic test to determine a patient’s risk and possible need for vitamin E supplementation could be considered a very prudent expenditure.
Of course, some of the best ways to prevent the costs associated with cardiovascular disease is to maintain a healthy lifestyle; eat a diet low in sodium, fat and cholesterol; exercise regularly; avoid smoking; avoid drinking in excess; and keep weight, blood pressure, cholesterol and stress levels at manageable level.
Mary Taylor Hyde is a Registered and Licensed Dietitian specializing in research and Dr. Dave Vigerust is the Chief Science Officer at MyGenetx Laboratory. Currently, MyGenetx is the only laboratory in the region offering a rapid, cost-effective molecular test for Hp genotyping. MyGenetx is a CLIA certified molecular laboratory that offers molecular testing to physicians.
WEB:
MyGenetx: www.mygenetx.com