Diagnostics in cardiometabolic disease

We live in an increasingly on-demand world. Everything from food to furniture can be accessed from the comfort of our homes, but how might this sedentary lifestyle impact our health?

Indulging in a delicacy on a lazy Saturday is an enjoyable part of the human experience. However, poor dietary choices and lack of activity in excess can have a severe impact on one’s health.

Cardiometabolic disease is not a single ailment, but rather a spectrum of conditions.1 Early intervention is crucial to prevent complications. This might already be indicated when the body develops a resistance to insulin—an important hormone that helps control blood sugar (glucose) levels and allows the body to get the energy it needs. If this resistance is not addressed, it can progress to type 2 diabetes and metabolic syndrome (a combination of diabetes, high blood pressure and obesity) before evolving into more severe conditions including cardiovascular disease (CVD).2

From early identification and supporting last-minute intervention to self-management devices, digital and diagnostic solutions help improve the quality of patients’ lives.
Cardiovascular disease is the number one cause of mortality, accounting for 31% of all global deaths—75% of which occur in low- and middle-income countries.³

Most cardiovascular diseases can be prevented by addressing certain risk factors, such as tobacco use, unhealthy diet and obesity, physical inactivity, and harmful use of alcohol.3 However, the reality of many situations is that early warning signs are ignored and diagnostic solutions are required to inform appropriate intervention.

The use of tests to assess risk, screen, diagnose, predict, and monitor cardiac disease have been essential tools in protecting patients, helping to reduce anxiety, avoid overcrowding of the emergency department, and help save lives. Today, advanced technologies and our evolved understanding of disease present new opportunities to personalise treatment, reduce unnecessary costs, and protect people in their time of need.

We've identified three key areas in which diagnostic advances can have the greatest impact on patient well-being:

In the case of suspected heart attack, prompt intervention is essential. Accelerating diagnosis can help decrease a patient’s anxiety, reduce overcrowding in emergency room settings, and reduce costs on the healthcare system.

By using specific biomarkers healthcare professionals can improve the accuracy of heart failure diagnosis, predict future probability of an incident and help identify patients at risk of hospital readmission or death4,5. Over time, these markers can even provide insight into patients' disease progression and suggest adjustments to treatment.6-10

In people with this type of irregular heartbeat, biomarkers can inform more personalized predictions of bleeding risk, help to reduce strokes, and curtail healthcare costs.

Diabetes affects about 463 million people¹¹ and costs an estimated 1.3 trillion USD annually (~1.8% of the global GDP).¹²

Managing diabetes relies largely on strong cooperation between people living with this chronic disease and their physicians. If optimal blood glucose levels are not maintained, the heart, blood vessels, eyes, kidneys, and nerves can be damaged.

Education, glucose monitoring and support by the healthcare teams are key to any successful diabetes therapy. Digital solutions help physicians to identify glucose patterns and determine the appropriate therapy adjustments. Furthermore, they support people with diabetes in their daily self-management.

Diabetes comes in many forms. While each presents a unique set of challenges, they all require close collaboration between people with diabetes and their healthcare teams.

The classification of diabetes comprises six types thereof other rare specific forms as well as hybrid and unclassified forms. All diabetes types have a different genetic background. The main types are:

While it can occur at any age, T1D is one of the most frequent diseases in childhood that, at present, cannot be prevented. It is life-threatening when not treated with insulin. People with type 1 diabetes can live active and fulfilling lives but only with the provision of an uninterrupted supply of external insulin, using daily injections and insulin pumps, for example.

Accounting for the vast majority (around 90%) of diabetes cases worldwide,15 T2D is characterized by reduced insulin production as well as by impaired insulin action (resistance). Type 2 diabetes can be effectively managed through adoption of healthy lifestyles (e.g., diet adaptation and increased physical activity)14 combined with medication (pills and/or injectable hormones like GLP-1 and insulin), as required. In many cases, drug treatment can be prevented or delayed with healthy lifestyles. Being a chronic condition and due to its genetic causes, T2D is likely to progress over time.

Gestational Diabetes is diabetes first detected during pregnancy. Pregnant women who develop transient gestational diabetes can have babies that are large for gestational age. This increases the risk of pregnancy- and birth-related complications for both the mother and baby whilst bearing an increased risk of developing a T2D later in life.

Transforming testing for patients and providers

Roche is the global market leader in cardiac biomarkers. As such, we understand the importance of time, both for patients and healthcare professionals. This inspired our development of a complete set of diagnostic solutions that answer more questions in key decision-making moments, from laboratories and emergency departments to people’s homes.

When patients come in with non-specific symptoms, diagnosing the cause can be difficult. The traditional way of testing uses an echocardiogram which is heavy on medical resources and can be time-consuming—time that person may not have.

We identified a special type of biomarker, the, which can be used to help diagnose, assess disease severity, monitor heart failure, or help predict bleeding risk. This enhances the ability of clinicians to make the right call earlier, allowing them to improve outcomes and quality of life while also reducing the cost of care.15

Chest pain is often a tell-tale sign of a problem. When patients suspected of a heart attack arrive in the emergency department, a fast and accurate diagnosis is critical to reducing patient anxiety, avoiding overcrowding in the ED, and saving cost to the health system.

Through a combination of technical improvements and supporting the right clinical studies we have improved the way heart attacks are diagnosed around the world, as well as assessing the risk of complications after major surgery.16-18

is an irregular and often rapid heart rate which is a big (and growing) problem that puts people at risk of stroke. The primary stroke-prevention therapy is oral anticoagulants. While effective, they can increase a person’s risk of bleeding.

To help physicians gain insight into the bleeding risk of a patient, we developed a scoring method that measures the presence of specific biomarkers (Roche GDF-15, NT-proBNP and TnT-hs) that allow clinicians to better manage individual patients. This is true personalised medicine.

We envision a world where people with diabetes can live full and healthy lives, free from worrying about the daily grinds of their therapy.

That’s why we took diabetes management to the next level with an open ecosystem that integrates diabetes management solutions and services, and enables our strategy of integrated Personalised Diabetes Management (iPDM). From glucose monitoring and insulin delivery systems to one of the most popular diabetes management apps, we’re helping people to better manage their diabetes in everyday life—so they can experience true relief day and night.

For healthcare professionals, we developed digital solutions that provide deeper insights and a better understanding of the chronic condition, enabling more personalised and effective therapy adjustments which can promote better outcomes.

It’s about time

When people’s lives are at stake, Roche is invested in making a difference.

Cardiometabolic disease is an immense challenge for humanity and a personal challenge for us. For more than 30 years we have delivered unique diagnostic solutions to mitigate the burden these diseases have on people and healthcare systems. The numbers show that global incidence of cardiometabolic disease is accelerating,19 which means we have no plans on slowing down.


  1. American College for Cardiology. Cardiometabolic Initiatives. https://www.acc.org/tools-and-practice-support/quality-programs/cardiometabolic-health-alliance. Accessed March 9, 2021.

  2. Guo F, Moellering DR, Garvey WT. The progression of cardiometabolic disease: validation of a new cardiometabolic disease staging system applicable to obesity. Obesity (Silver Spring). 2014;22(1):110-118.

  3. World Health Organization. Cardio Vascular Diseases (CVDs). https://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds). Accessed March 9, 2021.

  4. Bettencourt P, Azevedo A, Pimenta J, Friões F, Ferreira S, Ferreira A. N-terminal-pro-brain natriuretic peptide predicts outcome after hospital discharge in heart failure patients. Circulation. 2004;110(15):2168-2174.

  5. Salah K, Kok WE, Eurlings LW, et al. A novel discharge risk model for patients hospitalised for acute decompensated heart failure incorporating N-terminal pro-B-type natriuretic peptide levels: a European coLlaboration on Acute decompeNsated Heart Failure: ELAN-HF Score. Heart. 2014;100(2):115-125.

  6. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016;18(8):891-975.

  7. Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136(6):e137-e161.

  8. Masson S, Latini R, Anand IS, et al. Prognostic value of changes in N-terminal pro-brain natriuretic peptide in Val-HeFT (Valsartan Heart Failure Trial). J Am Coll Cardiol. 2008;52(12):997-1003.

  9. Zile MR, Claggett BL, Prescott MF, et al. Prognostic Implications of Changes in N-Terminal Pro-B-Type Natriuretic Peptide in Patients With Heart Failure. J Am Coll Cardiol. 2016;68(22):2425-2436.

  10. McKie PM, Burnett JC Jr. NT-proBNP: The Gold Standard Biomarker in Heart Failure. J Am Coll Cardiol. 2016;68(22):2437-2439.

  11. International Diabetes Federation. Diabetes Atlas 9th Edition (2019) – Global Fact Sheet. http://diabetesatlas.org/upload/resources/material/20201028_180116_Global-factsheet-final.pdf. Accessed March 9, 2021.

  12. Bommer C, Heesemann E, Sagalova V, et al. The global economic burden of diabetes in adults aged 20-79 years: a cost-of-illness study. Lancet Diabetes Endocrinol. 2017;5(6):423-430.

  13. National Institute of Diabetes and Digestive and Kidney Diseases. Managing Diabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/managing-diabetes. Accessed March 9, 2021.

  14. International Diabetes Federation. Type 2 Diabetes. https://www.idf.org/aboutdiabetes/type-2-diabetes.html. Accessed March 9, 2021.

  15. Ponikowski P, Anker SD, AlHabib KF, et al. Heart failure: preventing disease and death worldwide. ESC Heart Fail. 2014;1(1):4-25.

  16. Twerenbold R, Costabel JP, Nestelberger T, et al. Outcome of Applying the ESC 0/1-hour Algorithm in Patients With Suspected Myocardial Infarction. J Am Coll Cardiol. 2019;74(4):483-494.

  17. Chew DP, Lambrakis K, Blyth A, et al. A Randomized Trial of a 1-Hour Troponin T Protocol in Suspected Acute Coronary Syndromes: The Rapid Assessment of Possible Acute Coronary Syndrome in the Emergency Department With High-Sensitivity Troponin T Study (RAPID-TnT). Circulation. 2019;140(19):1543-1556.

  18. Stoyanov KM, Hund H, Biener M, et al. RAPID-CPU: a prospective study on implementation of the ESC 0/1-hour algorithm and safety of discharge after rule-out of myocardial infarction. Eur Heart J Acute Cardiovasc Care. 2020;9(1):39-51.

  19. Amegah AK. Tackling the Growing Burden of Cardiovascular Diseases in Sub-Saharan Africa. Circulation. 2018;138(22):2449-2451.

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