Exercise Training, Cardiac Biomarkers, and Cardiorespiratory Fitness in Type 2 Diabetes: The HART-D Study

Kershaw V Patel; Amit Saha; Colby R Ayers; Anand Rohatgi; Jarett D Berry; Jaime P Almandoz; Neil M Johannsen; Christopher deFilippi; Timothy S Church; James A de Lemos; Ambarish Pandey

doi:10.1016/j.jacadv.2022.100174

Exercise Training, Cardiac Biomarkers, and Cardiorespiratory Fitness in Type 2 Diabetes: The HART-D Study

JACC Adv. 2023 Jan 27;2(1):100174. doi: 10.1016/j.jacadv.2022.100174. eCollection 2023 Jan.

Affiliations

¹ Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
² Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
³ School of Kinesiology, College of Human Sciences & Education, Louisiana State University, Baton Rouge, Louisiana, USA.
⁴ Inova Heart and Vascular Institute, Falls Church, Virginia, USA.
⁵ Preventive Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA.

Abstract

Background: High-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are cardiac biomarkers commonly detected in adults with type 2 diabetes (T2D) and are associated with heart failure risk.

Objectives: The purpose of this study was to evaluate the effects of exercise training (ET) on hs-cTnT and NT-proBNP and evaluate the associations of these biomarkers with cardiorespiratory fitness among adults with T2D.

Methods: Participants of the HART-D (Health Benefits of Aerobic and Resistance Training in Individuals with Type 2 Diabetes) trial who were randomly assigned to one of 3 ET groups or a non-exercise control group were included. Cardiac biomarkers and cardiorespiratory fitness (evaluated by peak oxygen uptake [VO_2peak]) were assessed at baseline and after 9 months. The effects of ET (3 ET groups pooled) vs non-exercise control on hs-cTnT and NT-proBNP were assessed using separate analysis of covariance models. Multivariable-adjusted linear regression was performed to identify factors associated with follow-up biomarkers and ΔVO_2peak.

Results: The present study included 166 participants randomized to the ET (n = 135) and non-exercise control (n = 31) groups. Compared with the non-exercise control, ET did not significantly change hs-cTnT or NT-proBNP. In adjusted analysis, each ET group and ΔVO_2peak were not significantly associated with hs-cTnT or NT-proBNP levels on follow-up. Among individuals in the ET group, baseline hs-cTnT was inversely associated with ΔVO_2peak [per 1 SD higher log (hs-cTnT): β = -0.08 (95% CI = -0.15 to -0.01)].

Conclusions: Among individuals with T2D, ET did not modify cardiac biomarkers. Higher baseline hs-cTnT was associated with blunted cardiorespiratory fitness improvement in response to exercise.

Keywords: N-terminal pro-B-type natriuretic peptide; exercise training; high-sensitivity cardiac troponin T; type 2 diabetes.