Endothelial markers may link kidney function to cardiovascular events in type 2 diabetes mellitus
[
]
09.07.2009, 18:05
Objective: The increased cardiovascular risk in diabetes mellitus has been linked to endothelial and renal dysfunction. The aim of this study was to investigate the role of stable fragments of the precursors of adrenomedullin, endothelin-1, vasopressin and atrial natriuretic peptide in progression of cardiovascular disease in patients with diabetes mellitus. Research design and Methods: Prospective, observational study design with a composite endpoint (death or unexpected admission to hospital due to cardiovascular event) on 781 patients with type 2 diabetes (54 events, median duration of observation 15 months). The four stable precursor peptides MR-proADM, MR-proANP, CT-proET-1 and CT-proAVP (copeptin) were determined at baseline and their association to renal function and cardiovascular events was studied using stepwise linear, and Cox logistic regression analysis and ROC analysis, respectively. Results: MR-proADM, CT-proET-1, CT-proAVP and MR-proANP were all elevated in patients with future cardiovascular events and independently correlated to serum creatinine. MR-proADM and MR-proANP were significant predictors of a future cardiovascular event, with MR-proANP being the stronger (AUC 0.802 ± 0.034, sensitivity 0.833, specificity 0.576, positive predictive value 0.132, negative predictive value 0.978 with a cutoff value of 75 pmol/L). Conclusions: The four serum markers of vasoactive and natriuretic peptides are related to both kidney function and cardiovascular events, thus linking two major complications of diabetes mellitus, diabetic nephropathy and cardiovascular disease.
