Abstract
Introduction: Diabetes mellitus represents a significant global health burden, with affected individuals facing a markedly increased risk of vascular disease. Atherosclerosis, the primary pathological process underlying most cardiovascular events, develops earlier and progresses more rapidly in diabetic patients compared to the general population. The identification of novel biomarkers for early atherosclerosis detection in diabetes remains a critical unmet need in preventive vascular diseases.
Objectives: This study aimed to evaluate the potential utility of cathepsin D as a biomarker for early atherosclerosis detection in diabetic patients.
Patients and Methods: This case-control study, conducted at Ghazi Al-Hariri hospital in Baghdad from February to July 2024, included 100 diabetic patients with vascular atherosclerosis and 50 healthy controls. Demographic and clinical data were collected through interviews and medical records, while blood samples were processed to measure serum cathepsin D and lipid profiles. The study outcomes were assessing the association between cathepsin D levels and the presence and severity of vascular atherosclerosis in diabetic patients, as well as evaluating the diagnostic accuracy of cathepsin D for identifying and stratifying atherosclerotic risk.
Results: The results demonstrated that higher cathepsin D concentrations were significantly associated with increased odds of vascular atherosclerosis in diabetic patients, with an unadjusted and adjusted odds ratio (OR) of 2.08 and 1.71, respectively. In terms of diagnostic utility, cathepsin D showed excellent discriminatory accuracy for identifying vascular atherosclerosis, with an area under the curve (AUC) of 0.940 (95% CI: 0.903–0.978). At a cut-off value of 9.45 ng/mL, cathepsin D achieved a sensitivity of 91% and specificity of 84%. Additionally, cathepsin D levels increased in parallel with the severity of atherosclerosis; diabetic patients at low, moderate, and high risk exhibited progressively higher mean concentrations, with all group differences reaching statistical significance.
Conclusion: In conclusion, the results demonstrated that elevated cathepsin D levels are significantly and independently associated with both the presence and severity of vascular atherosclerosis in diabetic patients. Cathepsin D also shows strong diagnostic accuracy, highlighting its potential as a valuable biomarker for early detection and risk assessment of vascular complications in this population.