Prof. Ronald Ma
Professor and Head of Division of Endocrinology and Diabetes, Department of Medicine and Therapeutics, The Chinese University of Hong Kong

Uncovering the Cardio-renal Risks of Chinese T2DM patients: Back to the Future with CUHK!


  • Prof. Ronald Ma embarked on a study to investigate if NT-proBNP as a single biomarker has a similar or better performance in stratifying high risk groups & predicting the future cardio-renal risk of complications in DM patients compared to existing risk algorithms.
  • The study would make use of 2000 stored biobank samples of T2DM patients.
  • NT-proBNP would be measured retrospectively for the data analysis.

Q1. What are the objectives and design of the Hong Kong Diabetes Biobank (HKDB) study?

So in 2014, we established, with support from the major research grant, and in collaboration with other endocrine colleagues across Hong Kong, the Hong Kong Diabetes Biobank (HKDB). The purpose of the HKDB is to establish a multi-centre prospective cohort with detailed clinical information, standardized collection of biospecimens and standardized procedures of complication assessment, in order to identify and validate novel biomarkers for predicting diabetes complications. To date, the Biobank has recruited over 20,000 patients with diabetes and has become an invaluable resource for clinical, biomarker and genomic research.

Q2. What are the gaps the study is trying to address for the CV risk assessment in
T2DM patients?

One of the major objective of setting up the HKDB is to identify and replicate biomarkers that can predict the risk of cardio-renal complications in people with diabetes. Whilst there are established risk engines and risk equations for predicting cardiovascular (CV) risk in people with T2DM, we wish to investigate whether adding novel biomarkers can improve CV risk assessment beyond that provided by risk equations based on traditional clinical risk factors. Having genotyped a large proportion of the biobank, we also aim to identify novel genetic factors associated with CV risk in T2DM.

Q3. Why is NT-proBNP selected for the study?

We have decided to measure NT-proBNP in our cohort as it has been shown to be a useful biomarker that can help to stratify CV risk in terms of Cardiovascular Disease (CVD) and Congestive Heart Failure (CHF), and has been shown to be useful for risk stratification in various clinical trials. Given its proven clinical utility of NT-proBNP for CV risk prediction, it would be a useful biomarker to compare against.

Q4. What is the JADE score and how do you foresee NT-proBNP complementing it?

In our earlier work using the Hong Kong Diabetes Register, we have previously developed risk equations that are helpful to predict CV endpoints and hospitalization with heart failure in Asian subjects with diabetes. These have subsequently been incorporated into the Joint Asia Diabetes Evaluation (JADE) electronic portal. In our current work, we are examining the performance of NT-proBNP compared to these risk equations for predicting CV endpoints and to see whether incorporating NT-proBNP can further enhance the performance of the JADE risk equations for predicting cardio-renal events in diabetes.

Q5. How do you hope the study results will influence clinical practice?

We hope the results will provide useful insights on the role of NT-proBNP for predicting cardiovascular and other endpoints in Asian patients with T2DM. Our analyses should also provide new data to highlight how the biomarker can be used in routine clinical practice for risk stratification.

Q6. When is the expected timeline for the completion of the study?

We have completed measurements and most analyses and we hope we will be able to share the results with the community in the near future.

Updates from Leading Experts

STRONG-HF: Post-discharge Heart Failure Management and Implementation of GDMT Heart Failure Therapy

Prof Alexandre Mebazaa shares the key results and highlights from the STRONG-HF study that assessed the safety, tolerability of optimization of guideline directed medical therapy. [...]


CANVAS study: NT-proBNP and CVD risk reduction

Can you give us a short description of the CANVAS program? The CANVAS program was a set of two trials, whose goal was to evaluate the role of an SGLT2...

1 July 2021
Dr James L Januzzi