Background
Methods
Study population
Laboratory analysis
Echocardiograms
CV outcomes
Statistical analysis
Results
Clinical and laboratory characteristics
All (n = 320) | T2DM (−) (n = 184) | T2DM (+) (n = 136) | p value | |
---|---|---|---|---|
Age, years | 65 ± 12 | 64 ± 12 | 66 ± 11 | 0.108 |
Male, n (%) | 218 (68) | 135 (73) | 83 (61) | 0.021 |
Physical sign | ||||
Body mass index, kg/m2
| 25.4 ± 3.5 | 25.3 ± 3.4 | 25.5 ± 3.6 | 0.661 |
Systolic BP, mmHg | 129 ± 21 | 128 ± 19 | 132 ± 24 | 0.090 |
Diastolic BP, mmHg | 74 ± 12 | 74 ± 12 | 74 ± 12 | 0.078 |
Cardiovascular risk factors | ||||
Current smoking | 117 (37) | 73 (40) | 44 (32) | 0.179 |
History of smoking | 146 (46) | 91 (50) | 55 (40) | 0.114 |
Hypertension | 205 (64) | 112 (61) | 93 (68) | 0.195 |
Hyperlipidemia | 174 (54) | 91 (50) | 83 (61) | 0.042 |
Previous CAD | 72 (23) | 44 (24) | 28 (21) | 0.502 |
Previous MI | 39 (12) | 21 (11) | 18 (13) | 0.730 |
Previous PCI or CABG | 59 (18) | 34 (19) | 25 (18) | 1.000 |
Previous stroke | 43 (13) | 24 (13) | 19 (14) | 0.869 |
ACS diagnosis and treatment | ||||
ST elevation MI | 101 (31) | 58 (31) | 43 (31) | 0.985 |
Non-ST elevation MI | 82 (26) | 47 (26) | 35 (26) | 0.969 |
Unstable angina | 137 (43) | 79 (43) | 58 (43) | 0.959 |
PCI | 168 (53) | 94 (51) | 74 (54) | 0.556 |
CABG | 11 (3) | 3 (2) | 8 (6) | 0.080 |
Medical therapy | ||||
ASA | 309 (97) | 180 (98) | 129 (95) | 0.257 |
Y2P12 inhibitor | 231 (72) | 132 (72) | 99 (73) | 0.835 |
Statin | 293 (92) | 170 (92) | 123 (90) | 0.535 |
β-Blocker | 240 (75) | 133 (72) | 107 (79) | 0.192 |
ACEI/ARBs | 229 (72) | 129 (70) | 100 (74) | 0.503 |
LVEF, % | 59 ± 12 | 60 ± 12 | 56 ± 12 | 0.001 |
Laboratory assessment | ||||
Fasting glucose, mmol/l | 6.6 ± 3.0 | 5.5 ± 1.7 | 8.2 ± 3.5 | <0.001 |
HbA1C, % | 6.5 ± 1.5 | 5.7 ± 0.5 | 7.6 ± 1.8 | <0.001 |
Total cholesterol, mmol/l | 4.3 ± 1.0 | 4.2 ± 1.0 | 4.4 ± 1.1 | 0.322 |
Triglycerides, mmol/l | 1.85 ± 1.21 | 1.65 ± 1.04 | 2.13 ± 1.37 | <0.001 |
LDL-C, mmol/l | 2.24 ± 0.59 | 2.23 ± 0.59 | 2.24 ± 0.59 | 0.937 |
HDL-C, mmol/l | 0.93 ± 0.22 | 0.94 ± 0.21 | 0.92 ± 0.23 | 0.229 |
AST, U/L | 68.2 ± 94.6 | 67.1 ± 83.9 | 69.7 ± 107.7 | 0.333 |
ALT, U/L | 28.2 ± 24.9 | 27.4 ± 22.8 | 29.2 ± 27.5 | 0.607 |
Creatinine µmol/l | 102.3 ± 117.4 | 101.5 ± 118.5 | 103.4 ± 116.6 | 0.961 |
hsCRP, ng/ml | 7.3 ± 5.8 | 6.5 ± 5.7 | 8.4 ± 5.9 | <0.001 |
PAPP-A, ng/ml | 15.8 ± 15.3 | 13.3 ± 13.9 | 19.3 ± 16.4 | <0.001 |
CK-MB, ng/ml | 14.8 ± 37.1 | 17.9 ± 44.7 | 10.6 ± 22.8 | 0.713 |
Troponin I, ng/ml | 3.3 ± 8.4 | 3.2 ± 8.3 | 3.5 ± 8.4 | 0.474 |
NT-proBNP, pg/ml | 2352.5 ± 5746.6 | 1745.8 ± 4603.3 | 3173.4 ± 6937.3 | 0.128 |
eGFR, ml/min 1.73 m2
| 81.3 ± 23.4 | 82.7 ± 21.6 | 79.4 ± 25.6 | 0.217 |
CV outcomes
Unadjusted and adjusted association between PAPP-A and CV outcomes
All (n = 320) | T2DM (−) (n = 184) | T2DM (+) (n = 136) | ||||
---|---|---|---|---|---|---|
HR (95% CI) | p value | HR (95% CI) | p value | HR (95% CI) | p value | |
Age, per 1SD | 1.65 (1.26–2.17) | <0.001 | 1.42 (0.94–2.15) | 0.09 | 1.82 (1.25–2.63) | 0.002 |
Male gender | 1.45 (0.87–2.41) | 0.2 | 0.69 (0.26–1.84) | 0.5 | 1.85 (0.97–3.53) | 0.06 |
BMI, per 1SD | 0.84 (0.65–1.09) | 0.2 | 0.82 (0.55–1.23) | 0.3 | 0.84 (0.60–1.18) | 0.3 |
Hypertension | 2.04 (1.12–3.70) | 0.02 | 2.75 (1.03–7.33) | 0.04 | 1.47 (0.69–3.11) | 0.3 |
Hyperlipidemia | 0.81 (0.49–1.34) | 0.4 | 0.76 (0.34–1.67) | 0.5 | 0.74 (0.39–1.40) | 0.4 |
Previous CAD | 1.54 (0.90–2.64) | 0.12 | 2.19 (0.98–4.88) | 0.055 | 1.24 (0.59–2.64) | 0.6 |
Previous stroke | 1.07 (0.53–2.16) | 0.9 | 1.62 (0.61–4.31) | 0.3 | 0.74 (0.26–2.09) | 0.6 |
LVEF (%), per 1SD | 0.70 (0.55–0.88) | 0.003 | 0.61 (0.43–0.86) | 0.005 | 0.87 (0.63–1.20) | 0.4 |
HbA1C, per 1SD | 1.32 (1.06–1.63) | 0.01 | 0.82 (0.51–1.31) | 0.4 | 1.14 (0.82–1.57) | 0.4 |
log10(TG), per 1SD | 0.92 (0.72–1.19) | 0.5 | 0.89 (0.60–1.33) | 0.6 | 0.82 (0.58–1.15) | 0.2 |
TC, per 1SD | 0.87 (0.67–1.13) | 0.3 | 0.94 (0.62–1.42) | 0.8 | 0.80 (0.58–1.11) | 0.2 |
HDL-C, per 1SD | 0.95 (0.73–1.23) | 0.7 | 0.81 (0.52–1.27) | 0.4 | 1.05 (0.77–1.44) | 0.8 |
LDL-C, per 1SD | 0.88 (0.68–1.14) | 0.3 | 1.06 (0.71–1.57) | 0.8 | 0.77 (0.56–1.07) | 0.12 |
GFR, per 1SD | 0.60 (0.48–0.74) | <0.001 | 0.65 (0.47–0.90) | 0.008 | 0.57 (0.42–0.77) | <0.001 |
CK-MB, per 1SD | 1.01 (0.79–1.31) | 0.9 | 1.16 (0.86–1.57) | 0.3 | 0.85 (0.56–1.31) | 0.5 |
Troponin I, per 1SD | 1.30 (1.10–1.54) | 0.002 | 1.23 (0.92–1.66) | 0.2 | 1.33 (1.10–1.62) | 0.004 |
hsCRP, per 1SD | 1.84 (1.43–2.37) | <0.001 | 1.77 (1.20–2.60) | 0.004 | 1.75 (1.25–2.46) | 0.001 |
log10(PAPP-A), per 1SD | 3.10 (2.48–3.87) | <0.001 | 3.16 (2.27–4.39) | <0.001 | 2.97 (2.11–4.18) | <0.001 |
All (n = 320) | T2DM (−) (n = 184) | T2DM (+) (n = 136) | ||||
---|---|---|---|---|---|---|
HR (95% CI)* | % Δ** (%) | HR (95% CI)* | % Δ** (%) | HR (95% CI)* | %Δ** (%) | |
Unadjusted | 3.10 (2.48–3.87) | 0 | 3.16 (2.27–4.39) | 0 | 2.97 (2.11–4.18) | 0 |
Adjusted for | ||||||
Age | 2.93 (2.34–3.66) | −5 | 3.04 (2.14–4.32) | −4 | 3.16 (2.21–4.53) | 6 |
Sex | 3.05 (2.44–3.82) | −1 | 3.36 (2.36–4.79) | 7 | 3.04 (2.14–4.31) | 2 |
LVEF (%) | 3.02 (2.41–3.79) | −3 | 2.96 (2.11–4.17) | −6 | 2.97 (2.11–4.19) | 0 |
HbA1C | 3.06 (2.43–3.86) | −1 | 3.18 (2.23–4.55) | 1 | 2.98 (2.11–4.19) | 0 |
Troponin I | 3.09 (2.46–3.88) | 0 | 3.18 (2.27–4.45) | 1 | 2.89 (2.05–4.07) | −3 |
hsCRP | 2.86 (2.21–3.69) | −8 | 2.95 (2.02–4.30) | −7 | 2.79 (1.88–4.13) | −6 |
Predictive effects of PAPP-A on CV outcomes
All (n = 320) | T2DM (−) (n = 184) | T2DM (+) (n = 136) | ||||
---|---|---|---|---|---|---|
AUC (95% CI) | p value | AUC (95% CI) | p value | AUC (95% CI) | p value | |
PAPP-A | 0.80 (0.74–0.87) | Ref. | 0.78 (0.67–0.88) | Ref. | 0.79 (0.70–0.87) | Ref. |
Diabetes | 0.61 (0.54–0.67) | <0.001 | ||||
Age | 0.65 (0.58–0.73) | 0.003 | 0.60 (0.48–0.72) | 0.051 | 0.69 (0.59–0.79) | 0.15 |
LVEF (%) | 0.60 (0.52–0.68) | <0.001 | 0.66 (0.54–0.77) | 0.06 | 0.52 (0.40–0.64) | <0.001 |
eGFR | 0.66 (0.58–0.74) | <0.001 | 0.64 (0.52–0.76) | 0.051 | 0.66 (0.56–0.77) | 0.03 |
hsCRP | 0.68 (0.60–0.75) | 0.003 | 0.69 (0.57–0.80) | 0.2 | 0.64 (0.52–0.76) | 0.01 |
Multivariate (all above) | 0.83 (0.77–0.89) | 0.12 | 0.80 (0.70–0.90) | 0.2 | 0.83 (0.75–0.91) | 0.051 |