Cathepsin D improves the prediction of undetected diabetes in patients with myocardial infarction

Autor:	Jerzy Leppert, Johan Ärnlöv, Christoph Nowak, Tove Fall, Nina Dahle, Åke Tenerz, Matthijs A. Velders, Emil Hagström, Fredrik Calais, Pär Hedberg
Jazyk:	angličtina
Rok vydání:	2019
Předmět:	Blood Glucose Hospitals County Male Myocardial Infarction Cathepsin D lcsh:Medicine Cohort Studies 0302 clinical medicine Myocardial infarction Prospective Studies Incidental Findings 030219 obstetrics & reproductive medicine Incidence food and beverages General Medicine Articles Hospitalization Endokrinologi och diabetes diabetes mellitus Cardiology Female Cardiovascular outcomes medicine.medical_specialty acute myocardial infarction 030209 endocrinology & metabolism Acute myocardial infarction Endocrinology and Diabetes Risk Assessment 03 medical and health sciences proteomics Internal medicine Diabetes mellitus medicine Humans In patient Glycated Hemoglobin Sweden business.industry lcsh:R Klinisk medicin Type 2 Diabetes Mellitus biomarkers Glucose Tolerance Test medicine.disease Logistic Models Diabetes Mellitus Type 2 Multivariate Analysis Clinical Medicine business Follow-Up Studies
Zdroj:	Upsala Journal of Medical Sciences, Vol 124, Iss 3, Pp 187-192 (2019) Upsala Journal of Medical Sciences
ISSN:	2000-1967 0300-9734
Popis:	Background: Newer therapeutic agents for type 2 diabetes mellitus can improve cardiovascular outcomes, but diabetes remains underdiagnosed in patients with myocardial infarction (MI). We sought to identify proteomic markers of undetected dysglycaemia (impaired fasting glucose, impaired glucose tolerance, or diabetes mellitus) to improve the identification of patients at highest risk for diabetes. Materials and methods: In this prospective cohort, 626 patients without known diabetes underwent oral glucose tolerance testing (OGTT) during admission for MI. Proximity extension assay was used to measure 81 biomarkers. Multivariable logistic regression, adjusting for risk factors, was used to evaluate the association of biomarkers with dysglycaemia. Subsequently, lasso regression was performed in a 2/3 training set to identify proteomic biomarkers with prognostic value for dysglycaemia, when added to risk factors, fasting plasma glucose, and glycated haemoglobin A1c. Determination of discriminatory ability was performed in a 1/3 test set. Results: In total, 401/626 patients (64.1%) met the criteria for dysglycaemia. Using multivariable logistic regression, cathepsin D had the strongest association with dysglycaemia. Lasso regression selected seven markers, including cathepsin D, that improved prediction of dysglycaemia (area under the receiver operator curve [AUC] 0.848 increased to 0.863). In patients with normal fasting plasma glucose, only cathepsin D was selected (AUC 0.699 increased to 0.704). Conclusions: Newly detected dysglycaemia, including manifest diabetes, is common in patients with acute MI. Cathepsin D improved the prediction of dysglycaemia, which may be helpful in the a priori risk determination of diabetes as a motivation for confirmatory OGTT. Trial registration:ClinicalTrials.gov identifier: NCT01452178.
Databáze:	OpenAIRE
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