Please use this identifier to cite or link to this item: http://hdl.handle.net/1946/15485
Background – Cardiovascular disease, e.g. coronary artery disease, is the main cause of death globally. The prognosis after acute myocardial infarction (AMI) is more severe for patients with type 2 diabetes (T2DM) than without. This is not completely explained by hyperglycemia and traditional CV-risk factors. Hence the search for novel risk factors and/or riskmarkers is important. In this report two riskmarkers: Copeptin, a marker for vasopressin, and IGFBP-1, one of IGF binding proteins, are investigated.
Methods – Copeptin and IGFBP-1 were analyzed in patients (age: 70, male: 70%) with T2DM and AMI participating in the DIGAMI2 trial. Samples were analyzed at admission (n=393), at discharge (n=309) and after three months (n=288). The primary endpoint was cardiovascular events (cardiovascular death, AMI, and stroke) (CVevent).
Results – The median copeptin levels at admission were 21.8 pmol/l, at discharge 8.5 pmol/l and after three months 8.40 pmol/l. There were significant correlations between copeptin at admission, discharge and after three months. In an unadjusted Cox Regression Hazard analysis, both biomarkers independently predicted CVevent at all occasion. In a multiple model including both biomarkers, copeptin was a predictor of all events apart from non-fatal reinfarction and stroke at discharge while IGFBP-1 did not remain as an independent predictor of cardiovascular event. In the final multiple model, including age and creatinine clearance, copeptin remained an independent predictor for all events at admission and after three months but not at discharge.
Conclusions – Copeptin levels were elevated at admission, then decreased relatively fast and stabilized. There was a relationship between copeptin and IGFBP-1 throughout the study period. Furthermore, copeptin was a stronger predictor for cardiovascular events, both at admission and after three months. These findings may have implications for the understanding of the association between diabetes and cardiovascular disease and could be a potentially pharmacological target. Copeptin, IGFBP-1 and cardiovascular prognosis in patients with type 2 diabetes during and after acute myocardial infarction