BOSTON -- New studies by an international team of scientists led by Joslin Diabetes Center have found variations in a gene that help explain why people with type 2 diabetes are at much greater risk for coronary artery disease, the leading cause of death for this group.
"We now have potential gene markers to help identify diabetes patients at increased risk for heart disease," said Alessandro Doria, M.D., Ph.D., Investigator in Joslin's Genetics and Epidemiology research section, Director of Joslin's Genetics Core and Assistant Professor of Medicine at Harvard Medical School. "This knowledge could potentially lead to drugs or other methods that affect this pathway, reducing risk of heart attack and stroke in these patients."
An estimated 18 million people in the United States have type 2 diabetes. People with diabetes are two to four times more likely to have cardiovascular disease, and are at increased risk for stroke, blindness, kidney disease and nerve damage.
In a two-part study published in the Oct. 1 edition of the British journal Human Molecular Genetics, Dr. Doria and his colleagues at Joslin and other research centers in the Northeast and researchers in Italy focused on a gene governing a protein called CD36. This protein is found in the membrane of several types of cells, including the walls of blood vessels.
Previous studies had shown that, among other functions, CD36 is involved in transporting free fatty acids into cells. It also is a scavenger of oxidized "bad" cholesterol LDL at the arterial wall. All are major players in contributing to atherosclerosis -- the dangerous buildup of plaque that can lead to partial or complete blockage of the artery, leading to heart attack or stroke.
In the first part of this study, the researchers mapped the structure of the CD36 gene, which consists of hundreds of nucleic acids strung together like beads on a spiral necklace. They were looking for variants in this sequence that are associated with increased risk of heart disease.
Studying 585 people who did not have diabetes, the researchers found five different CD36 variations that were associated with increased levels of free fatty acids and triglycerides. When all five variants were factored together, a strong link emerged -- the highest levels of fatty acids and triglycerides occurred in people with a specific variant combination.
Using this new knowledge as a basis for a second study, they studied 518 people in both the United States and Italy. All had type 2 diabetes. In addition, nearly half of these subjects also had heart disease, as shown by heart catheterization indicating more than 50 percent blockage of at least one coronary artery. The others did not have any visible heart disease.
The researchers mapped out each person's CD36 gene variations, then compared those results with the presence of known heart disease. Again, there was a strong link: People with that specific variant combination in the CD36 gene were 60 percent more likely to have heart disease.
"While this research is a significant starting point for assessing risk of heart disease, a constellation of factors are involved," said Dr. Doria. "But it is clear that in addition to high blood pressure, high cholesterol and environmental factors such as smoking, genes are important determinants of heart disease in people with type 2 diabetes."
An International Research Team
In addition to Dr. Doria, other Joslin researchers included Xiaowei Ma, M.D., and Wojciech Mlynarski, M.D. Other U.S. researchers included Michael T. Johnstone, M.D., and Ernest Gervino, Sc.D., of the Cardiology Division at Beth Israel Deaconess Medical Center, Boston; Richard W. Nesto, M.D., of the Heart and Vascular Center, Lahey Clinic, Burlington, MA; and Nada Abumrad, Ph.D., of the State University of New York, Stony Brook. Researchers from Italy included Vincenzo Trischitta, M.D., of the Scientific Institute 'Casa Sollievo della Sofferenza,' San Giovanni Rotondo; and Angelo Avogaro, M.D., of the University of Padova. The research was funded by the National Institutes of Health and the American Heart Association.
About Joslin Diabetes Center
Joslin Diabetes Center, dedicated to conquering diabetes in all of its forms, is the global leader in diabetes research, care and education. Founded in 1898, Joslin is affiliated with Harvard Medical School. Joslin research is a team of over 300 people at the forefront of discovery aimed at preventing and curing diabetes. Joslin Clinic, affiliated with Beth Israel Deaconess Medical Center in Boston, the nationwide network of Joslin Affiliated Programs, and the hundreds of Joslin educational programs offered each year for clinicians, researchers and patients, enable Joslin to develop, implement and share innovations that immeasurably improve the lives of people with diabetes. As a nonprofit, Joslin benefits from the generosity of donors in advancing its mission. For more information on Joslin, call 1-800-JOSLIN-1 or visit http://www.joslin.org
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