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Cardiovasc Diabetol. 2017 Apr 5;16(1):45. doi: 10.1186/s12933-017-0526-6.

Pregnancy-associated plasma protein-A is a stronger predictor for adverse cardiovascular outcomes after acute coronary syndrome in type-2 diabetes mellitus.

Author information

1
Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
2
Key Laboratory, Metabolic Disorders Related Cardiovascular Disease, Beijing, China.
3
The Mountain-Whisper-Light Statistics, Seattle, WA, USA.
4
Clinical Atherosclerosis Research Lab, Division of Cardiology, University of Washington, Seattle, WA, USA.
5
Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China. lhw19656@sina.com.
6
Key Laboratory, Metabolic Disorders Related Cardiovascular Disease, Beijing, China. lhw19656@sina.com.
7
Clinical Atherosclerosis Research Lab, Division of Cardiology, University of Washington, Seattle, WA, USA. xueqiao@uw.edu.

Abstract

BACKGROUND:

The risk prediction of pregnancy-associated plasma protein-A (PAPP-A) for future cardiovascular (CV) events post acute coronary syndrome (ACS) in patients with type-2 diabetes mellitus (T2DM) was investigated in comparison to other risk factors.

METHODS:

PAPP-A was measured at hospital admission in 320 consecutive ACS patients (136 with T2DM and 184 without). All patients were followed for 2 years for occurrence of CV death, non-fatal MI or stroke. Effect of PAPP-A on the CV event risk was estimated using Cox regression models. Receiver operating characteristics (ROC) curves were generated to demonstrate the sensitivity and specificity of PAPP-A in predicting CV events.

RESULTS:

ACS patients with T2DM had higher PAPP-A (19.29 ± 16.36 vs. 13.29 ± 13.90 ng/ml, p < 0.001) and higher rate of CV events 2 years post ACS (27.2 vs. 13.6%, p = 0.002) than those without. Higher levels of PAPP-A were significantly associated with increased risk of CV events during 2-year follow-up [HR = 2.97 for 1 SD increase in log10(PAPP-A), 95% CI 2.11-4.18, p < 0.001] in T2DM and (HR = 3.16, 95% CI 2.27-4.39, p < 0.001) in non-T2DM. Among patients with T2DM, PAPP-A showed a larger area under the curve (AUC 0.79) that was significantly more predictive than hsCRP (AUC 0.64), eGFR (AUC 0.66) and LVEF < 50% (AUC 0.52); predictive ability did not improve significantly by including those factors into the model.

CONCLUSIONS:

Patients with T2DM had higher levels of PAPP-A and increased risk of CV events. Elevated PAPP-A compared to other risk factors was a stronger predictor for future CV events 2 years post ACS in patients with T2DM. Trial registration ISRCTN10805074. Registered on 20 January 2017, retrospectively registered.

KEYWORDS:

Acute coronary syndrome; Cardiovascular outcomes; Pregnancy-associated plasma protein-A; Type-2 diabetes mellitus

PMID:
28381225
PMCID:
PMC5382447
DOI:
10.1186/s12933-017-0526-6
[Indexed for MEDLINE]
Free PMC Article

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