Interleukin-6 and activin A are independently associated with cardiovascular events and mortality in type 2 diabetes: the prospective Asker and Bærum Cardiovascular Diabetes (ABCD) cohort study

Autor: Anne Pernille Ofstad, Svend Aakhus, Pål Aukrust, Morten W. Fagerland, Kåre I. Birkeland, Elsa Orvik, Lars Gullestad, Thor Ueland, Odd Erik Johansen, Knut Endresen
Jazyk: angličtina
Předmět:
Male
Time Factors
Endocrinology
Diabetes and Metabolism
Myocardial Infarction
Type 2 diabetes
Ventricular Function
Left
Electrocardiography
Risk Factors
Medicine
Longitudinal Studies
Prospective Studies
Prospective cohort study
Original Investigation
Framingham Risk Score
Middle Aged
Prognosis
Risk prediction
Activins
Hospitalization
Stroke
C-Reactive Protein
Cardiovascular Diseases
Cohort
Cardiology
Disease Progression
Female
Cardiology and Cardiovascular Medicine
Cohort study
Echocardiography
Stress
medicine.medical_specialty
Cardiovascular event
MACE
Predictive Value of Tests
Internal medicine
Ventricular Pressure
Humans
Angina
Unstable
Aged
Proportional Hazards Models
Chi-Square Distribution
business.industry
Unstable angina
Proportional hazards model
Interleukin-6
medicine.disease
Cardiovascular risk
Logistic Models
Diabetes Mellitus
Type 2
Microalbuminuria
Inflammatory marker
business
Biomarkers
Zdroj: Cardiovascular Diabetology
ISSN: 1475-2840
DOI: 10.1186/1475-2840-12-126
Popis: Background Novel and robust cardiovascular (CV) markers are needed to improve CV morbidity and mortality risk prediction in type 2 diabetes (T2D). We assessed the long term predictive value of 4 novel CV risk markers for major CV events and mortality. Methods We included patients with T2D who had cytokines (interleukin [IL]-6 and activin A [actA]), a maximum stress ECG test (evaluated by the normalization pattern in early recovery phase) and echocardiography (evaluated by a measure of the left ventricular filling pressure - E/Em) assessed at baseline. The primary endpoint was time to first of any of the following events: myocardial infarction, stroke, hospitalization for unstable angina pectoris and death. All outcomes were adjudicated by independent experts. We used Cox proportional hazard modeling, Harrell C-statistic and the net reclassification improvement (NRI) to assess the additional value beyond conventional markers (age, gender, prior CV disease, HDL, creatinine, diastolic BP, microalbuminuria). Results At baseline the study cohort (n = 135, mean age/diabetes duration/HbA1c: 59 yrs/7 yrs/7.6% [59 mmol/mol], 26% females) had moderate elevated CV risk (42% microalbuminuria, mean Framingham 10 year CV-risk 9.6%). During 8.6 yrs/1153.7 person years, 26 patients experienced 36 events. All 4 novel risk markers were significantly associated with increased risk of the primary endpoint, however, only IL-6 and actA improved C-statistic and NRI (+0.119/43.2%, +0.065/20.3% respectively) compared with the conventional CV risk factors. Conclusions IL-6 and actA may provide prognostic information on CV events and mortality in T2D beyond conventional CV risk factors. Trial registration ClinicalTrials.gov: NCT00133718
Databáze: OpenAIRE
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