Urinary liver-type fatty acid binding protein is an independent predictor of stroke and mortality in individuals with type 1 diabetes

被引:15
作者
Panduru, Nicolae M. [1 ,2 ,3 ,4 ,5 ]
Forsblom, Carol [2 ,3 ,4 ,5 ]
Saraheimo, Markku [2 ,3 ,4 ,5 ]
Thorn, Lena M. [2 ,3 ,4 ,5 ]
Gordin, Daniel [2 ,3 ,4 ,5 ]
Elonen, Nina [2 ,3 ,4 ,5 ]
Harjutsalo, Valma [2 ,3 ,4 ,5 ,6 ]
Bierhaus, Angelika [7 ]
Humpert, Per M. [7 ,8 ]
Groop, Per-Henrik [2 ,3 ,4 ,5 ,9 ]
机构
[1] Carol Davila Univ Med & Pharm, Diabet Nutr & Metab Disorders Unit, Clin Dept 2, Bucharest, Romania
[2] Univ Helsinki, Folkhalsan Inst Genet, Folkhalsan Res Ctr, Biomedicum 1 Helsinki,Haartmaninkatu 8,POB 63, FI-00014 Helsinki, Finland
[3] Univ Helsinki, Diabet & Obes, Res Programmes Unit, Helsinki, Finland
[4] Univ Helsinki, Abdominal Ctr Nephrol, Helsinki, Finland
[5] Helsinki Univ Hosp, Helsinki, Finland
[6] Natl Inst Hlth & Welf, Chron Dis Prevent Unit, Helsinki, Finland
[7] Heidelberg Univ, Dept Med & Clin Chem 1, Heidelberg, Germany
[8] Stoffwechselzentrum Rhein Pfalz, Mannheim, Germany
[9] Baker IDI Heart & Diabet Inst, Melbourne, Vic, Australia
基金
芬兰科学院;
关键词
Cardiovascular disease; Diabetic complications; Liver-type fatty acid binding protein; Mortality; Stroke; Type; 1; diabetes; Urinary biomarkers; Urinary L-FABP; ALL-CAUSE MORTALITY; CARDIOVASCULAR-DISEASE; METABOLIC SYNDROME; CLINICAL-SIGNIFICANCE; HEART-DISEASE; RISK-FACTORS; BRAIN-TYPE; NEPHROPATHY; PROGRESSION; ASSOCIATION;
D O I
10.1007/s00125-017-4328-x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims/hypothesis In type 1 diabetes, cardiovascular disease (CVD) and diabetic nephropathy progress in parallel, thereby potentiating the risk of premature death during their development. Since urinary liver-type fatty acid binding protein (L-FABP) predicts the progression of diabetic nephropathy, the aim of this study was to investigate whether urinary L-FABP also predicts cardiovascular outcomes and mortality. Methods We tested our hypothesis in a Finnish cohort of 2329 individuals with type 1 diabetes and a median follow-up of 14.1 years. The L-FABP to creatinine ratio was determined from baseline urine samples. The predictive value of urinary L-FABP was evaluated using Cox regression models, while its added predictive benefit for cardiovascular outcomes and mortality was evaluated using a panel of statistical indexes. Results Urinary L-FABP predicted incident stroke independently of traditional risk factors (HR 1.33 [95% CI 1.20, 1.49]) and after further adjustment for eGFR (HR 1.28 [95% CI 1.14, 1.44]) or AER (HR 1.24 [95% CI 1.06, 1.44]). In addition, it predicted mortality independently of traditional risk factors (HR 1.34 [95% CI 1.24, 1.45]), and after adjustment for eGFR (HR 1.29 [95% CI 1.18, 1.39]) or AER (HR 1.22 [95% CI 1.09, 1.36]). Urinary L-FABP was as good a predictor as eGFR or AER, and improved the AUC for both outcomes on top of traditional risk factors, with no reclassification benefit (integrated discrimination improvement/net reclassification improvement) for stroke or mortality when AER or eGFR were added to traditional risk factors. However, urinary L-FABP was not a predictor of other cardiovascular endpoints (coronary artery disease, peripheral vascular disease and overall CVD events) when adjusted for the AER. Conclusions/interpretation Urinary L-FABP is an independent predictor of stroke and mortality in individuals with type 1 diabetes.
引用
收藏
页码:1782 / 1790
页数:9
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