Cardiovascular biomarkers in clinical studies of type 2 diabetes

When planning cardiovascular studies in type 2 diabetes, selection of cardiovascular biomarkers is a complex issue. Since the pathophysiology of cardiovascular disease in type 2 diabetes is multifactorial, ideally, the selected cardiovascular biomarkers should cover all aspects of the known pathophysiology of the disease. This will allow the researcher to distinguish between effects on different aspects of the pathophysiology. To this end, we will discuss a host of biomarkers grouped according to their role in the pathogenesis of CV disease, namely: 1) cardiac damage biomarkers 2) inflammatory biomarkers and 3) novel biomarkers (oxidative stress and endothelial dysfunction biomarkers). Within each category we present the currently best validated biomarkers with special focus on the population of interest (type 2 diabetes). For each individual biomarker, the physiological role, the validation in the general population and in type 2 diabetes, analytical methodology, the modifying factors, the effects of glucose-lowering drugs, and the interpretation are discussed. This approach will provide clinical researchers with all information necessary for planning, conducting and interpreting results from clinical trials. Furthermore, a systematic approach to selection of cardiovascular biomarkers in type 2 diabetes research will improve the quality of future research.