Researchers studied nearly 4,000 people with type 2 diabetes to understand how a simple blood test could predict heart problems and whether weight loss could help. They found that people with higher levels of a heart-related protein in their blood had a greater risk of developing heart failure. The good news: people who participated in an intensive weight loss and lifestyle program and had elevated levels of this protein saw their heart failure risk drop significantly. This suggests that for certain people with diabetes, losing weight through diet and exercise changes might be one of the best ways to protect their hearts.

The Quick Take

  • What they studied: Can a blood test that measures heart stress help doctors figure out who will get heart problems, and can weight loss prevent those problems?
  • Who participated: 3,959 adults with type 2 diabetes who were overweight or obese, followed for about a year
  • Key finding: People with high levels of a heart-stress protein who did an intensive weight loss program cut their risk of one type of heart failure by more than half, compared to those who only got diabetes education
  • What it means for you: If you have diabetes and are overweight, a simple blood test might show if your heart is at risk. If it is, losing weight through diet and exercise could significantly lower your chances of developing heart problems. However, this doesn’t work the same way for all types of heart failure, and you should talk to your doctor about your individual situation.

The Research Details

This was a large, carefully controlled study where researchers divided people with type 2 diabetes into two groups. One group received an intensive lifestyle intervention program focused on weight loss through diet and exercise changes. The other group received standard diabetes education and support. Researchers measured a specific protein in the blood called NT-proBNP at the start and after one year. This protein is like a warning signal that the heart is working harder than normal.

The researchers then tracked both groups to see who developed heart failure over time. They looked at two different types of heart failure: one where the heart doesn’t pump blood out efficiently (HFrEF) and one where the heart is stiff and doesn’t relax properly (HFpEF). By comparing what happened in each group, they could see whether the lifestyle program helped prevent heart problems, especially in people who had high levels of the warning protein.

This study design is important because it shows cause and effect, not just correlation. By randomly assigning people to different programs and following them over time, researchers can be more confident that the weight loss program actually caused the reduction in heart problems, rather than other factors being responsible. The blood test measurement gives doctors an objective way to identify who is at highest risk and might benefit most from intensive intervention.

This study has several strengths: it included nearly 4,000 participants, which is a large sample size that makes results more reliable; it was a randomized controlled trial, which is considered the gold standard in medical research; and it followed people for an extended period to see real-world outcomes. The study was published in a respected medical journal. However, the participants were primarily overweight or obese adults with diabetes, so results may not apply equally to all populations. Additionally, most participants were followed for about a year, so we don’t know if benefits last longer.

What the Results Show

The study found that people with elevated levels of the heart-stress protein (NT-proBNP) at the beginning had a significantly higher risk of developing heart failure compared to those with normal levels. This was true for both types of heart failure studied.

The most important finding was that the intensive weight loss program worked differently depending on the person’s starting protein level. For people who started with high protein levels, the weight loss program cut their risk of one type of heart failure (HFpEF) by about 53%. In contrast, for people who started with normal protein levels, the weight loss program didn’t provide the same protective benefit.

Another positive finding: people whose protein levels stayed stable or decreased over the first year of the program had better protection against heart failure with the weight loss intervention. Those whose protein levels increased over the year didn’t see the same benefit from the program.

Interestingly, the weight loss program didn’t significantly reduce the risk of the other type of heart failure (HFrEF) regardless of protein levels, suggesting that weight loss may work differently for different types of heart problems.

The study revealed that the blood test (NT-proBNP) is a useful tool for identifying people at highest risk. People with elevated baseline levels were at much greater risk for both types of heart failure. Additionally, changes in this protein level over time were important—people whose levels went up had worse outcomes, while those whose levels stayed the same or decreased did better. This suggests that monitoring this protein over time, not just measuring it once, gives doctors better information about heart health.

Previous research had shown that the NT-proBNP blood test could predict heart failure risk in people with diabetes. This study builds on that knowledge by showing that the test can also help identify which people will benefit most from weight loss interventions. It confirms that weight loss is beneficial for heart health in diabetes, but adds the important detail that the benefit may be greatest for people with the highest initial risk (those with elevated protein levels). This is consistent with the general principle that people at highest risk often benefit most from preventive interventions.

The study followed people for only about one year, so we don’t know if the benefits continue over longer periods. The participants were mostly overweight or obese adults with type 2 diabetes, so results may not apply to people of normal weight or those without diabetes. The study didn’t measure exactly how much weight people lost or how well they stuck to the program, which could affect results. Additionally, the study only showed that the weight loss program reduced risk of one type of heart failure (HFpEF), not the other type (HFrEF), so the benefits aren’t universal across all heart problems. Finally, the study was conducted in a research setting with intensive support, which may be different from what people can achieve in regular medical practice.

The Bottom Line

If you have type 2 diabetes and are overweight or obese, ask your doctor about getting a NT-proBNP blood test to assess your heart failure risk. If your level is elevated, participating in an intensive lifestyle program focused on weight loss through diet and exercise changes appears to significantly reduce your risk of developing certain types of heart failure. This recommendation has moderate to strong evidence support based on this study. Work with your healthcare team to develop a realistic weight loss plan that includes both dietary changes and regular physical activity. Monitor your progress and have your blood test repeated to see if your protein levels improve.

This research is most relevant for adults with type 2 diabetes who are overweight or obese. It’s particularly important for those with elevated NT-proBNP levels, as they appear to benefit most from intensive lifestyle intervention. People without diabetes or those with normal weight may not see the same benefits. People with existing heart failure should work closely with their cardiologist, as this study focused on prevention, not treatment of established disease. Older adults and those with other serious health conditions should discuss whether these recommendations apply to them.

Based on this study, you might expect to see improvements in your heart-stress protein levels within the first year of consistent weight loss and lifestyle changes. However, the full protective benefit against heart failure development may take several years to become apparent. This is a long-term investment in your health, not a quick fix. Realistic weight loss is typically 1-2 pounds per week, so significant weight loss takes months to achieve.

Want to Apply This Research?

  • Track weekly weight changes and monthly measurements of physical activity minutes (aim for 150 minutes of moderate activity per week). If your doctor orders the NT-proBNP blood test, record the results and dates to monitor trends over time.
  • Set a specific, achievable goal such as ‘Walk 30 minutes, 5 days per week’ or ‘Reduce daily calorie intake by 500 calories.’ Use the app to log daily meals, exercise sessions, and weight. Create reminders for meal planning and exercise sessions. Share progress with your healthcare provider during regular visits.
  • Establish a monthly check-in routine where you review your weight trend, activity levels, and dietary patterns. Request NT-proBNP blood tests annually or as recommended by your doctor to track heart health markers. Use the app’s trend analysis features to identify patterns in what helps you succeed. Celebrate small wins like consistent exercise weeks or stable weight maintenance, as these are steps toward heart protection.

This research summary is for educational purposes only and should not be used as medical advice. The findings apply specifically to adults with type 2 diabetes who are overweight or obese. Individual results may vary, and the study focused on prevention rather than treatment of existing heart disease. Before starting any weight loss program or making significant lifestyle changes, especially if you have diabetes or heart concerns, consult with your healthcare provider. Your doctor can assess your individual risk factors, order appropriate blood tests, and create a personalized plan. This study shows associations and trends but does not prove that weight loss will prevent heart failure in every individual. Always work with your medical team to monitor your health and adjust your plan as needed.