Noemi Pavo1, Raphael Wurm1, Stephanie Neuhold2, Christopher Adlbrecht1, Greisa Vila3, Guido Strunk4, Martin Clodi5, Michael Resl5, Helmut Brath6, Rudolf Prager7, Anton Luger3, Richard Pacher1, Martin Hülsmann8. 1. Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria. 2. Department of Anesthesia, Division of Cardio-Thoracic-Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria. 3. Department of Internal Medicine III, Division of Endocrinology, Medical University of Vienna, Vienna, Austria. 4. Technical University Dortmund, Dortmund, Germany; FH Campus Vienna, Vienna, Austria and Complexity Research, Vienna, Austria. 5. Department of Internal Medicine, Hospital Barmherzige Brüder Linz, Linz, Austria. 6. Health Center South, Diabetes Outpatient Clinic, Vienna, Austria. 7. Department of Medicine III, Hospital Hietzing, Vienna, Austria. 8. Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria; martin.huelsmann@meduniwien.ac.at.
Abstract
BACKGROUND: Diabetes has been linked epidemiologically to increased cancer incidence and mortality. Growth differentiation factor 15 (GDF-15) is increased in patients with diabetes and has recently been linked to the occurrence of cancer. We investigated whether circulating GDF-15 concentrations can predict the incidence of malignant diseases in a diabetic patient cohort already facing increased risk for cancer. METHODS: We prospectively enrolled a total of 919 patients with type 2 diabetes and no history of malignant disease, who were clinically followed up for 60 months. GDF-15, N-terminal pro-B-type natriuretic peptide and troponin T were measured at baseline; an additional 4 cardiovascular biomarkers were determined for a subpopulation (n = 259). Study end point was defined as the first diagnosis of any type of cancer during the follow-up period. RESULTS: During a median follow-up of 60 months, 66 patients (7.2%) were diagnosed with cancer. Baseline circulating GDF-15 concentrations were higher in patients that developed cancer over the follow-up period when compared to cancer-free patients. Increased GDF-15 concentrations were significantly associated with cancer incidence [crude hazard ratio (HR) per 1-IQR (interquartile range) increase 2.13, 95% CI 1.53-2.97, P < 0.001]. This effect persisted after multivariate adjustment with an adjusted HR of 1.86 (95% CI 1.22-2.84; P = 0.004). Among the 4 additionally tested cardiovascular markers in the subpopulation, only troponin T and C-terminal proendothelin-1 showed a significant association with future cancer incidence with unadjusted HRs of 1.71 (95% CI 1.28-2.28, P < 0.001) and 1.68 (95% CI 1.02-2.76, P = 0.042), respectively. CONCLUSIONS: Increased circulating concentrations of GDF-15 are associated with increased cancer incidence in patients with type 2 diabetes.
BACKGROUND:Diabetes has been linked epidemiologically to increased cancer incidence and mortality. Growth differentiation factor 15 (GDF-15) is increased in patients with diabetes and has recently been linked to the occurrence of cancer. We investigated whether circulating GDF-15 concentrations can predict the incidence of malignant diseases in a diabeticpatient cohort already facing increased risk for cancer. METHODS: We prospectively enrolled a total of 919 patients with type 2 diabetes and no history of malignant disease, who were clinically followed up for 60 months. GDF-15, N-terminal pro-B-type natriuretic peptide and troponin T were measured at baseline; an additional 4 cardiovascular biomarkers were determined for a subpopulation (n = 259). Study end point was defined as the first diagnosis of any type of cancer during the follow-up period. RESULTS: During a median follow-up of 60 months, 66 patients (7.2%) were diagnosed with cancer. Baseline circulating GDF-15 concentrations were higher in patients that developed cancer over the follow-up period when compared to cancer-freepatients. Increased GDF-15 concentrations were significantly associated with cancer incidence [crude hazard ratio (HR) per 1-IQR (interquartile range) increase 2.13, 95% CI 1.53-2.97, P < 0.001]. This effect persisted after multivariate adjustment with an adjusted HR of 1.86 (95% CI 1.22-2.84; P = 0.004). Among the 4 additionally tested cardiovascular markers in the subpopulation, only troponin T and C-terminal proendothelin-1 showed a significant association with future cancer incidence with unadjusted HRs of 1.71 (95% CI 1.28-2.28, P < 0.001) and 1.68 (95% CI 1.02-2.76, P = 0.042), respectively. CONCLUSIONS: Increased circulating concentrations of GDF-15 are associated with increased cancer incidence in patients with type 2 diabetes.
Authors: Henrike Arfsten; Anna Cho; Claudia Freitag; Markus Raderer; Georg Goliasch; Philipp E Bartko; Raphael Wurm; Guido Strunk; Heinz Gisslinger; Christine Marosi; Gabriela Kornek; Christoph Zielinski; Martin Hülsmann; Noemi Pavo Journal: Eur J Clin Invest Date: 2019-09-26 Impact factor: 4.686
Authors: Taha Sen; Jingwei Li; Brendon L Neuen; Clare Arnott; Bruce Neal; Vlado Perkovic; Kenneth W Mahaffey; Wayne Shaw; William Canovatchel; Michael K Hansen; Hiddo J L Heerspink Journal: J Am Heart Assoc Date: 2021-12-02 Impact factor: 6.106
Authors: Patrícia Lourenço; Filipe M Cunha; João Ferreira-Coimbra; Isaac Barroso; João-Tiago Guimarães; Paulo Bettencourt Journal: ESC Heart Fail Date: 2021-05-02