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Pregnancy-associated plasma protein-A is a stronger predictor for adverse cardiovascular outcomes after acute coronary syndrome in type-2 diabetes mellitus
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. PAPP-A was measured at hospital admission in 320 conse...
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| Published in: | Cardiovascular diabetology 2017-04, Vol.16 (1), p.45-11, Article 45 |
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| container_title | Cardiovascular diabetology |
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| creator | Li, Wei-Ping Neradilek, Moni B Gu, Fu-Sheng Isquith, Daniel A Sun, Zhi-Jun Wu, Xing Li, Hong-Wei Zhao, Xue-Qiao |
| description | 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.
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.
ACS patients with T2DM had higher PAPP-A (19.29 ± 16.36 vs. 13.29 ± 13.90 ng/ml, p |
| doi_str_mv | 10.1186/s12933-017-0526-6 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_doaj_</sourceid><recordid>TN_cdi_doaj_primary_oai_doaj_org_article_8b3623a680e64dfcb8f96a520b94b556</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><doaj_id>oai_doaj_org_article_8b3623a680e64dfcb8f96a520b94b556</doaj_id><sourcerecordid>1894808210</sourcerecordid><originalsourceid>FETCH-LOGICAL-c493t-3c5a58881b2dcd0ef495dc78e8c9daf5f81bf9849a30346dee73dac4a19be6393</originalsourceid><addsrcrecordid>eNpVkt9qFDEUxgdRbK0-gDcS8Hpq_m9yI5RStVDQC70OZ5Iza5bZyZpkFvZZ-rJm3Vrai5Bwzvf9ckK-rnvP6CVjRn8qjFshespWPVVc9_pFd87kSvXcSPryyfmse1PKhjah0ex1d8aNMIxzdd7d_8i4nmH2hx5KST5CxUB2E5QtkF1OFePcX5FYCJBSc5rXmFsdQ_Q1ZTK2BWGPuSDxkENMeyh-mSCTtFSfttiMY20e8EttmtQQkA-kHOaQW5vEmdTDDntOQoQBazNscZpiXcrb7tUIU8F3D_tF9-vLzc_rb_3d96-311d3vZdW1F54BcoYwwYefKA4SquCXxk03gYY1dg6ozXSgqBC6oC4EgG8BGYH1MKKi-72xA0JNm6X47ZN6BJE96-Q8tpBrtFP6MwgNBegDUUtw-gHM1oNitPBykEp3VifT6zdMmwxeJxrhukZ9Hlnjr_dOu2dEoZLuWqAjw-AnP4sWKrbpCXP7f2OGSsNNZzRpmInlc-plIzj4w2MumM23Ckbrn25O2bDHUf78HS0R8f_MIi_hG66DQ</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1894808210</pqid></control><display><type>article</type><title>Pregnancy-associated plasma protein-A is a stronger predictor for adverse cardiovascular outcomes after acute coronary syndrome in type-2 diabetes mellitus</title><source>Open Access: PubMed Central</source><source>Publicly Available Content Database</source><creator>Li, Wei-Ping ; Neradilek, Moni B ; Gu, Fu-Sheng ; Isquith, Daniel A ; Sun, Zhi-Jun ; Wu, Xing ; Li, Hong-Wei ; Zhao, Xue-Qiao</creator><creatorcontrib>Li, Wei-Ping ; Neradilek, Moni B ; Gu, Fu-Sheng ; Isquith, Daniel A ; Sun, Zhi-Jun ; Wu, Xing ; Li, Hong-Wei ; Zhao, Xue-Qiao</creatorcontrib><description>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.
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.
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 log
(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.
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.</description><identifier>ISSN: 1475-2840</identifier><identifier>EISSN: 1475-2840</identifier><identifier>DOI: 10.1186/s12933-017-0526-6</identifier><identifier>PMID: 28381225</identifier><language>eng</language><publisher>England: BioMed Central</publisher><subject>Acute coronary syndrome ; Acute Coronary Syndrome - blood ; Acute Coronary Syndrome - diagnosis ; Acute Coronary Syndrome - etiology ; Acute Coronary Syndrome - mortality ; Acute coronary syndromes ; Adult ; Aged ; Aged, 80 and over ; Area Under Curve ; Biomarkers - blood ; Cardiovascular disease ; Cardiovascular outcomes ; Case-Control Studies ; Chi-Square Distribution ; Diabetes ; Diabetes mellitus ; Diabetes Mellitus, Type 2 - blood ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - diagnosis ; Diabetes Mellitus, Type 2 - mortality ; Enzymes ; Epidermal growth factor receptors ; Female ; Glucose ; Heart attacks ; Humans ; Inflammation ; Kaplan-Meier Estimate ; Laboratories ; Logistic Models ; Male ; Measurement methods ; Middle Aged ; Multivariate Analysis ; Non-ST Elevated Myocardial Infarction - blood ; Non-ST Elevated Myocardial Infarction - diagnosis ; Non-ST Elevated Myocardial Infarction - etiology ; Non-ST Elevated Myocardial Infarction - mortality ; Original Investigation ; Patient Admission ; Plasma ; Predictive Value of Tests ; Pregnancy ; Pregnancy-associated plasma protein-A ; Pregnancy-Associated Plasma Protein-A - analysis ; Prognosis ; Proportional Hazards Models ; Prospective Studies ; Proteins ; Recurrence ; Regression analysis ; Risk Assessment ; Risk Factors ; ROC Curve ; ST Elevation Myocardial Infarction - blood ; ST Elevation Myocardial Infarction - diagnosis ; ST Elevation Myocardial Infarction - etiology ; ST Elevation Myocardial Infarction - mortality ; Stroke ; Time Factors ; Type-2 diabetes mellitus ; Ultrasonic imaging ; Up-Regulation</subject><ispartof>Cardiovascular diabetology, 2017-04, Vol.16 (1), p.45-11, Article 45</ispartof><rights>Copyright BioMed Central 2017</rights><rights>The Author(s) 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c493t-3c5a58881b2dcd0ef495dc78e8c9daf5f81bf9849a30346dee73dac4a19be6393</citedby><cites>FETCH-LOGICAL-c493t-3c5a58881b2dcd0ef495dc78e8c9daf5f81bf9849a30346dee73dac4a19be6393</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5382447/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/1894808210?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,25732,27903,27904,36991,44569,53769,53771</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28381225$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Li, Wei-Ping</creatorcontrib><creatorcontrib>Neradilek, Moni B</creatorcontrib><creatorcontrib>Gu, Fu-Sheng</creatorcontrib><creatorcontrib>Isquith, Daniel A</creatorcontrib><creatorcontrib>Sun, Zhi-Jun</creatorcontrib><creatorcontrib>Wu, Xing</creatorcontrib><creatorcontrib>Li, Hong-Wei</creatorcontrib><creatorcontrib>Zhao, Xue-Qiao</creatorcontrib><title>Pregnancy-associated plasma protein-A is a stronger predictor for adverse cardiovascular outcomes after acute coronary syndrome in type-2 diabetes mellitus</title><title>Cardiovascular diabetology</title><addtitle>Cardiovasc Diabetol</addtitle><description>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.
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.
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 log
(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.
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.</description><subject>Acute coronary syndrome</subject><subject>Acute Coronary Syndrome - blood</subject><subject>Acute Coronary Syndrome - diagnosis</subject><subject>Acute Coronary Syndrome - etiology</subject><subject>Acute Coronary Syndrome - mortality</subject><subject>Acute coronary syndromes</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Area Under Curve</subject><subject>Biomarkers - blood</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular outcomes</subject><subject>Case-Control Studies</subject><subject>Chi-Square Distribution</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes Mellitus, Type 2 - blood</subject><subject>Diabetes Mellitus, Type 2 - complications</subject><subject>Diabetes Mellitus, Type 2 - diagnosis</subject><subject>Diabetes Mellitus, Type 2 - mortality</subject><subject>Enzymes</subject><subject>Epidermal growth factor receptors</subject><subject>Female</subject><subject>Glucose</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Inflammation</subject><subject>Kaplan-Meier Estimate</subject><subject>Laboratories</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Measurement methods</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Non-ST Elevated Myocardial Infarction - blood</subject><subject>Non-ST Elevated Myocardial Infarction - diagnosis</subject><subject>Non-ST Elevated Myocardial Infarction - etiology</subject><subject>Non-ST Elevated Myocardial Infarction - mortality</subject><subject>Original Investigation</subject><subject>Patient Admission</subject><subject>Plasma</subject><subject>Predictive Value of Tests</subject><subject>Pregnancy</subject><subject>Pregnancy-associated plasma protein-A</subject><subject>Pregnancy-Associated Plasma Protein-A - analysis</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Proteins</subject><subject>Recurrence</subject><subject>Regression analysis</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>ROC Curve</subject><subject>ST Elevation Myocardial Infarction - blood</subject><subject>ST Elevation Myocardial Infarction - diagnosis</subject><subject>ST Elevation Myocardial Infarction - etiology</subject><subject>ST Elevation Myocardial Infarction - mortality</subject><subject>Stroke</subject><subject>Time Factors</subject><subject>Type-2 diabetes mellitus</subject><subject>Ultrasonic imaging</subject><subject>Up-Regulation</subject><issn>1475-2840</issn><issn>1475-2840</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNpVkt9qFDEUxgdRbK0-gDcS8Hpq_m9yI5RStVDQC70OZ5Iza5bZyZpkFvZZ-rJm3Vrai5Bwzvf9ckK-rnvP6CVjRn8qjFshespWPVVc9_pFd87kSvXcSPryyfmse1PKhjah0ex1d8aNMIxzdd7d_8i4nmH2hx5KST5CxUB2E5QtkF1OFePcX5FYCJBSc5rXmFsdQ_Q1ZTK2BWGPuSDxkENMeyh-mSCTtFSfttiMY20e8EttmtQQkA-kHOaQW5vEmdTDDntOQoQBazNscZpiXcrb7tUIU8F3D_tF9-vLzc_rb_3d96-311d3vZdW1F54BcoYwwYefKA4SquCXxk03gYY1dg6ozXSgqBC6oC4EgG8BGYH1MKKi-72xA0JNm6X47ZN6BJE96-Q8tpBrtFP6MwgNBegDUUtw-gHM1oNitPBykEp3VifT6zdMmwxeJxrhukZ9Hlnjr_dOu2dEoZLuWqAjw-AnP4sWKrbpCXP7f2OGSsNNZzRpmInlc-plIzj4w2MumM23Ckbrn25O2bDHUf78HS0R8f_MIi_hG66DQ</recordid><startdate>20170405</startdate><enddate>20170405</enddate><creator>Li, Wei-Ping</creator><creator>Neradilek, Moni B</creator><creator>Gu, Fu-Sheng</creator><creator>Isquith, Daniel A</creator><creator>Sun, Zhi-Jun</creator><creator>Wu, Xing</creator><creator>Li, Hong-Wei</creator><creator>Zhao, Xue-Qiao</creator><general>BioMed Central</general><general>BMC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20170405</creationdate><title>Pregnancy-associated plasma protein-A is a stronger predictor for adverse cardiovascular outcomes after acute coronary syndrome in type-2 diabetes mellitus</title><author>Li, Wei-Ping ; Neradilek, Moni B ; Gu, Fu-Sheng ; Isquith, Daniel A ; Sun, Zhi-Jun ; Wu, Xing ; Li, Hong-Wei ; Zhao, Xue-Qiao</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c493t-3c5a58881b2dcd0ef495dc78e8c9daf5f81bf9849a30346dee73dac4a19be6393</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Acute coronary syndrome</topic><topic>Acute Coronary Syndrome - blood</topic><topic>Acute Coronary Syndrome - diagnosis</topic><topic>Acute Coronary Syndrome - etiology</topic><topic>Acute Coronary Syndrome - mortality</topic><topic>Acute coronary syndromes</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Area Under Curve</topic><topic>Biomarkers - blood</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular outcomes</topic><topic>Case-Control Studies</topic><topic>Chi-Square Distribution</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Diabetes Mellitus, Type 2 - blood</topic><topic>Diabetes Mellitus, Type 2 - complications</topic><topic>Diabetes Mellitus, Type 2 - diagnosis</topic><topic>Diabetes Mellitus, Type 2 - mortality</topic><topic>Enzymes</topic><topic>Epidermal growth factor receptors</topic><topic>Female</topic><topic>Glucose</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Inflammation</topic><topic>Kaplan-Meier Estimate</topic><topic>Laboratories</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Measurement methods</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Non-ST Elevated Myocardial Infarction - blood</topic><topic>Non-ST Elevated Myocardial Infarction - diagnosis</topic><topic>Non-ST Elevated Myocardial Infarction - etiology</topic><topic>Non-ST Elevated Myocardial Infarction - mortality</topic><topic>Original Investigation</topic><topic>Patient Admission</topic><topic>Plasma</topic><topic>Predictive Value of Tests</topic><topic>Pregnancy</topic><topic>Pregnancy-associated plasma protein-A</topic><topic>Pregnancy-Associated Plasma Protein-A - analysis</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Proteins</topic><topic>Recurrence</topic><topic>Regression analysis</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>ROC Curve</topic><topic>ST Elevation Myocardial Infarction - blood</topic><topic>ST Elevation Myocardial Infarction - diagnosis</topic><topic>ST Elevation Myocardial Infarction - etiology</topic><topic>ST Elevation Myocardial Infarction - mortality</topic><topic>Stroke</topic><topic>Time Factors</topic><topic>Type-2 diabetes mellitus</topic><topic>Ultrasonic imaging</topic><topic>Up-Regulation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Li, Wei-Ping</creatorcontrib><creatorcontrib>Neradilek, Moni B</creatorcontrib><creatorcontrib>Gu, Fu-Sheng</creatorcontrib><creatorcontrib>Isquith, Daniel A</creatorcontrib><creatorcontrib>Sun, Zhi-Jun</creatorcontrib><creatorcontrib>Wu, Xing</creatorcontrib><creatorcontrib>Li, Hong-Wei</creatorcontrib><creatorcontrib>Zhao, Xue-Qiao</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Cardiovascular diabetology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Li, Wei-Ping</au><au>Neradilek, Moni B</au><au>Gu, Fu-Sheng</au><au>Isquith, Daniel A</au><au>Sun, Zhi-Jun</au><au>Wu, Xing</au><au>Li, Hong-Wei</au><au>Zhao, Xue-Qiao</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pregnancy-associated plasma protein-A is a stronger predictor for adverse cardiovascular outcomes after acute coronary syndrome in type-2 diabetes mellitus</atitle><jtitle>Cardiovascular diabetology</jtitle><addtitle>Cardiovasc Diabetol</addtitle><date>2017-04-05</date><risdate>2017</risdate><volume>16</volume><issue>1</issue><spage>45</spage><epage>11</epage><pages>45-11</pages><artnum>45</artnum><issn>1475-2840</issn><eissn>1475-2840</eissn><abstract>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.
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.
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 log
(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.
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.</abstract><cop>England</cop><pub>BioMed Central</pub><pmid>28381225</pmid><doi>10.1186/s12933-017-0526-6</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Cardiovascular diabetology, 2017-04, Vol.16 (1), p.45-11, Article 45 |
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| source | Open Access: PubMed Central; Publicly Available Content Database |
| subjects | Acute coronary syndrome Acute Coronary Syndrome - blood Acute Coronary Syndrome - diagnosis Acute Coronary Syndrome - etiology Acute Coronary Syndrome - mortality Acute coronary syndromes Adult Aged Aged, 80 and over Area Under Curve Biomarkers - blood Cardiovascular disease Cardiovascular outcomes Case-Control Studies Chi-Square Distribution Diabetes Diabetes mellitus Diabetes Mellitus, Type 2 - blood Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - diagnosis Diabetes Mellitus, Type 2 - mortality Enzymes Epidermal growth factor receptors Female Glucose Heart attacks Humans Inflammation Kaplan-Meier Estimate Laboratories Logistic Models Male Measurement methods Middle Aged Multivariate Analysis Non-ST Elevated Myocardial Infarction - blood Non-ST Elevated Myocardial Infarction - diagnosis Non-ST Elevated Myocardial Infarction - etiology Non-ST Elevated Myocardial Infarction - mortality Original Investigation Patient Admission Plasma Predictive Value of Tests Pregnancy Pregnancy-associated plasma protein-A Pregnancy-Associated Plasma Protein-A - analysis Prognosis Proportional Hazards Models Prospective Studies Proteins Recurrence Regression analysis Risk Assessment Risk Factors ROC Curve ST Elevation Myocardial Infarction - blood ST Elevation Myocardial Infarction - diagnosis ST Elevation Myocardial Infarction - etiology ST Elevation Myocardial Infarction - mortality Stroke Time Factors Type-2 diabetes mellitus Ultrasonic imaging Up-Regulation |
| title | Pregnancy-associated plasma protein-A is a stronger predictor for adverse cardiovascular outcomes after acute coronary syndrome in type-2 diabetes mellitus |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-26T17%3A05%3A26IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_doaj_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Pregnancy-associated%20plasma%20protein-A%20is%20a%20stronger%20predictor%20for%20adverse%20cardiovascular%20outcomes%20after%20acute%20coronary%20syndrome%20in%20type-2%20diabetes%20mellitus&rft.jtitle=Cardiovascular%20diabetology&rft.au=Li,%20Wei-Ping&rft.date=2017-04-05&rft.volume=16&rft.issue=1&rft.spage=45&rft.epage=11&rft.pages=45-11&rft.artnum=45&rft.issn=1475-2840&rft.eissn=1475-2840&rft_id=info:doi/10.1186/s12933-017-0526-6&rft_dat=%3Cproquest_doaj_%3E1894808210%3C/proquest_doaj_%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c493t-3c5a58881b2dcd0ef495dc78e8c9daf5f81bf9849a30346dee73dac4a19be6393%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=1894808210&rft_id=info:pmid/28381225&rfr_iscdi=true |