Prevalent CVD impacts cardiovascular risk prediction in type 2 diabetes
medwireNews: The best markers for prediction of cardiovascular events in patients with type 2 diabetes may vary according to whether or not the patient already has cardiovascular disease (CVD), study findings indicate.
Jan Nilsson (Lund University, Sweden) and colleagues report in Diabetes Care that markers of inflammation and endothelial stress were associated with an increased risk for cardiovascular events in individuals with type 2 diabetes and prevalent CVD (myocardial infarction, stroke, or lower extremity arterial disease), whereas the severity of atherosclerosis predicted risk in those without prevalent CVD.
Of the 936 individuals included in the SUMMIT Vascular Imaging Prediction study, just under half (47%) had CVD at baseline. These patients were significantly more likely to experience a cardiovascular event during the 3-year follow-up period than those with no CVD at baseline, at a rate of 5.5 versus 2.2 cases per 100 life–years.
The team found that most conventional cardiovascular risk factors such as BMI, smoking status, lipid levels, and blood pressure, as well as measurements of arterial stiffness and endothelial reactivity, were not significantly associated with cardiovascular events in either group of patients.
However, baseline levels of glycated hemoglobin, the inflammatory biomarkers interleukin (IL)-6, chemokine ligand 3, pentraxin 3, and high sensitivity C-reactive protein (hs-CRP), and the endothelial mitogens hepatocyte growth factor and vascular endothelial growth factor A were all significantly higher in patients with baseline CVD who developed further CVD events compared with those who did not.
Levels of matrix metalloproteinase 12, N-terminal pro B-type natriuretic peptide, and fatty acid binding protein 4 were also significantly higher in the former group than the latter.
Moreover, the researchers found that adding IL-6 to a binary logistic regression model containing traditional risk factors improved its discrimination by 2.7 percentage points, while hs-CRP improved it by 1.6 percentage points.
By contrast, none of these biomarkers were associated with cardiovascular risk among patients without CVD at baseline. Instead, the patients with no CVD who subsequently experienced a cardiovascular event had significantly worse baseline atherosclerosis than those who did not (median carotid plaque area 30.4 vs 19.5 mm2).
They also had increased intima-media thickness (IMT) in both the left and right bulb and the right common carotid artery (CCA), and addition of right CCA IMT to the model containing traditional risk factors improved discrimination by 2.4 percentage points.
Nilsson et al say their findings indicate “a clear association between atherosclerosis severity and [cardiovascular] risk in subjects with [type 2 diabetes], but this association diminishes in subjects with manifest CVD.”
They add “One possible explanation for this could be that a more intense medical intervention in subjects with manifest CVD allows other risk factor mechanisms than those traditionally associated with atherosclerosis progression to become more important as causes of [cardiovascular] events.”
By Laura Cowen
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