Background and Aims: The aim of the study was to estimate the predictive value of some new biomarkers in the assessment of cardiovascular disease (CVD) risk in a type 2 diabetes (T2DM) population and to perform a correlation between the SCORE risk results and the risk profile estimated by the use of these biomarkers. Finally, we aimed to establish if the CVD risk assessment can be improved by adding the biomarkers into the SCORE risk equation. Material and Methods: In the study population the CVD risk assessment was performed using the SCORE High Risk Chart. The new individual biomarkers were: estimated glomerular filtration rate (eGFR), urinary albumin excretion (UAE) rate, albumin/creatinine ratio (UACR), cystatin C, plasminogen activator inhibitor-1 (PAI-1), high-sensitivity C-reactive protein (hs-CRP), high density lipoprotein cholesterol (HDL) and apolipoprotein B (apo-B). Results: The SCORE risk prediction model results were significantly altered by adding in the equation apo-B and HDLc values. An increase of one standard deviation of the apo-B values caused the increase of the SCORE results with 0.19 standard deviations while an increase of one standard deviation of the HDLc values decreased the SCORE results with 0.26 standard deviations. Conclusions: Advanced lipid testing, including the measurement of apo-B, provides a more comprehensive cardiac risk assessment and should be used in the development of specifically designed risk-scores for T2DM individuals.
If the inline PDF is not rendering correctly, you can download the PDF file here.
1. Gaede P Vedel P Larsen N Jensen GV Parving HH Pedersen O. Multifactorial interventions and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 348: 383-393 2003.
2. Unger J. Exploring the association between diabetes and cardiovascular disease. In: Diabetes Management in Primary Care. Zachary Schwartz (ed). Lippincot Williams & Wilkins Philadelphia pp 217-259 2013.
3. Jacobson TA Griffiths GG Varas C et al. Impact of evidence-based “clinical judgment” on the number of American adults requiring lipid-lowering therapy based on updated NHANES III data. National Health and Nutrition Examination Survey. Arch Intern Med 160: 1361-1369 2008.
4. Helfand M Buckley DI Freeman M et al. Emerging risk factors for coronary heart disease: a summary of systematic reviews conducted for the US Preventive Services Task Force. Ann Intern Med 151: 496-507 2009.
5. Sullivan DR Lewis B. Laboratory assessement of lipoproteins in diabetes. In: Lipoproteins in Diabetes Mellitus. Jenkins A Toth PP Lyons TJ (ed). Humana Press New York pp1-10 2014.
6. Genest J McPherson R Frohlich J et al. 2009 Canadian Cardiovascular Society/Canadian guidelines for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease in the adult - 2009 recommendations. Can J Cardiol 25: 567-579 2009.
7. Juutilainen A Lehto S Rönnemaa T Pyörälä K Laakso M. Type 2 diabetes as a „coronary heart disease equivalent”: an 18-year prospective populationbased study in Finnish subjects. Diabetes Care 28: 2901-2907 2005.
8. Chamnan P Simmons RK Sharp SJ Griffin SJ Wareham NJ. Cardiovascular risk assessment scores for people with diabetes: a systematic review. Diabetologia 52: 2001-2014 2009.
9. Pearson TA Mensah GA Alexander RW et al. Markers of inflammation and cardiovascular disease: application to clinical public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 107: 499-511 2003.
10. Sinderman AJ Williams K Contois JH et al. A metaanalysis of low-density lipoprotein cholesterol non high-density lipoprotein cholesterol and apolipoprotein B as markers of cardiovascular risk. Circ Cardiovasc Qual Outcomes 4: 337-345 2011.
11. Walldius G Jungner I Holme I Aastveit AH Kolar W Steiner E. High apolipoprotein B low apolipoprotein A-1 and improvement in the prediction of fatal myocardial infarction (AMORIS study): a prospective study. Lancet 358(9298): 2026-2033 2001.
12. Thompson A Danesh J. Associations between apolipoprotein B Apolipoprotein A1 the apolipoprotein B/A1 ratio and coronary heart disease: a literature based meta-analysis of prospective studies J Intern Med 259: 481-492 2006.