Katerina K Naka1, Katerina Papathanassiou2, Aris Bechlioulis1, Konstantinos Pappas1, Stelios Tigas3, Dimitrios Makriyiannis4, Sophia Antoniou5, Nikolaos Kazakos6, Alexandra Margeli7, Ioannis Papassotiriou8, Agathocles Tsatsoulis3, Lampros K Michalis1. 1. 2nd Department of Cardiology, Medical School, University of Ioannina, Ioannina 45110, Greece; Michaelidion Cardiac Center, Medical School, University of Ioannina, Ioannina 45110, Greece. 2. Michaelidion Cardiac Center, Medical School, University of Ioannina, Ioannina 45110, Greece; Department of Endocrinology, Medical School, University of Ioannina, Ioannina 45110, Greece. 3. Department of Endocrinology, Medical School, University of Ioannina, Ioannina 45110, Greece. 4. Department of Internal Medicine, Medical School, Ioannina General Hospital, Ioannina 45001, Greece. 5. Michaelidion Cardiac Center, Medical School, University of Ioannina, Ioannina 45110, Greece. 6. Michaelidion Cardiac Center, Medical School, University of Ioannina, Ioannina 45110, Greece; Intensive Care Unit, General Hospital of Arta, Arta 47100, Greece. 7. Department of Clinical Biochemistry, 'Aghia Sophia' Children's Hospital, Athens 11527, Greece. 8. Department of Clinical Biochemistry, 'Aghia Sophia' Children's Hospital, Athens 11527, Greece. Electronic address: biochem@paidon-agiasofia.gr.
Abstract
BACKGROUND: The pathophysiology of atherosclerosis in type 2 diabetes mellitus (T2DM) is multifactorial. The association of vascular indices with circulating biomarkers of inflammation and insulin resistance and their role in the long-term cardiovascular prognosis in T2DM patients were currently investigated. PATIENTS AND METHODS: Patients with T2DM and poor glycemic control without known cardiovascular diseases (n=119) at baseline were enrolled and followed for about 9years. The end-point was the occurrence of any cardiovascular event (coronary heart disease, stroke, peripheral artery disease or cardiovascular death). Aortic pulse wave velocity (PWV), augmentation index (AIx), brachial flow-mediated dilation (FMD), hsCRP, Chitinase-3-like protein 1 (YKL-40), Neutrophil Gelatinase-Associated Lipocalin (NGAL), Fatty Acid Binding Protein (FABP-4) were assessed. RESULTS: Higher YKL-40 and NGAL were associated with higher PWV, while higher YKL-40 and FABP-4 were related to higher AIx (p<0.05 for all). In univariate Cox regression analysis, PWV>10m/s, YKL-40>78ng/ml and NGAL>42ng/ml were associated with cardiovascular events (p<0.05 for all). In multivariate analysis, after adjusting for classical risk factors and glycemic control, increased NGAL, YKL-40 and PWV and decreased FMD (i.e. ≤2.2%) (p<0.05 for all) were independently associated with cardiovascular events. CONCLUSION: In T2DM patients without established cardiovascular disease, novel indices of vascular inflammation (NGAL and YKL-40) were associated with subclinical atherosclerosis (arterial stiffness) but also with adverse clinical prognosis. Arterial stiffness and endothelial dysfunction were also independently related to adverse prognosis.
BACKGROUND: The pathophysiology of atherosclerosis in type 2 diabetes mellitus (T2DM) is multifactorial. The association of vascular indices with circulating biomarkers of inflammation and insulin resistance and their role in the long-term cardiovascular prognosis in T2DM patients were currently investigated. PATIENTS AND METHODS: Patients with T2DM and poor glycemic control without known cardiovascular diseases (n=119) at baseline were enrolled and followed for about 9years. The end-point was the occurrence of any cardiovascular event (coronary heart disease, stroke, peripheral artery disease or cardiovascular death). Aortic pulse wave velocity (PWV), augmentation index (AIx), brachial flow-mediated dilation (FMD), hsCRP, Chitinase-3-like protein 1 (YKL-40), Neutrophil Gelatinase-Associated Lipocalin (NGAL), Fatty Acid Binding Protein (FABP-4) were assessed. RESULTS: Higher YKL-40 and NGAL were associated with higher PWV, while higher YKL-40 and FABP-4 were related to higher AIx (p<0.05 for all). In univariate Cox regression analysis, PWV>10m/s, YKL-40>78ng/ml and NGAL>42ng/ml were associated with cardiovascular events (p<0.05 for all). In multivariate analysis, after adjusting for classical risk factors and glycemic control, increased NGAL, YKL-40 and PWV and decreased FMD (i.e. ≤2.2%) (p<0.05 for all) were independently associated with cardiovascular events. CONCLUSION: In T2DM patients without established cardiovascular disease, novel indices of vascular inflammation (NGAL and YKL-40) were associated with subclinical atherosclerosis (arterial stiffness) but also with adverse clinical prognosis. Arterial stiffness and endothelial dysfunction were also independently related to adverse prognosis.
Authors: Monika Starzak; Agata Stanek; Grzegorz K Jakubiak; Armand Cholewka; Grzegorz Cieślar Journal: Int J Environ Res Public Health Date: 2022-08-19 Impact factor: 4.614