Insulin-like growth factor binding protein 1 predicts cardiovascular morbidity and mortality in patients with acute myocardial infarction and type 2 diabetes

Objective: There are indications that the IGF system is related to both type 2 diabetes (T2DM) and cardiovascular (CV) disease. We tested the hypothesis that low IGF-I and high IGF binding protein-1 (IGFBP-1) predict future cardiovascular mortality and morbidity in patients with acute myocardial infarction (AMI) and T2DM. Research design and methods: The DIGAMI 2 trial recruited 1253 patients with T2DM and AMI of which 575, the present material, were enrolled in a biochemical program with repeated blood sampling. Primary and secondary endpoints were adjudicated CV mortality and a composite of CV events (CV death, reinfarction or stroke). Multiple Cox proportional hazard regression was used to study the relationship between endpoints and the variables. Admission variables were used for the survival analysis and for blood glucose and HbA1c updated mean values during follow-up were also available. Results: During a median follow-up period of 2.2 years, 131 (23%) patients died from all-cause and 102 (18%) from CV disease while 175 patients (30%) suffered from at least one CV event. The independent predictors for CV death in the Cox regression model were (HR, 95% CI): ln updated mean blood glucose (12.2 (5.8 - 25.7), age (+5 years; 1.5, 1.4-1.7), ln IGFBP-1 (1.4, 1.1-1.8) and ln S-Creatinine at admission (2.4, 1.3-4.2). The model predicting CV events contained the same variables (ln IGFBP-1 at admission; 1.2, 1.0-1.4). Conclusions: High levels of IGFBP-1 at admission are associated with increased risk for CV mortality and morbidity in T2DM patients with AMI.

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