Copeptin, IGFBP-1, and cardiovascular prognosis in patients with type 2 diabetes and acute myocardial infarction: a report from the DIGAMI 2 trial.
OBJECTIVE
To determine whether C-terminal provasopressin (copeptin) explains the prognostic importance of insulin growth factor binding protein-1 (IGFBP-1) in patients with myocardial infarction and type 2 diabetes.


METHODS
Copeptin and IGFBP-1 were analyzed in 393 patients participating in the Diabetes Mellitus Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) 2 trial.


RESULTS
Copeptin was associated with IGFBP-1 (Spearman rank correlation test, r = 0.53; P < 0.001). During follow-up there were 138 cardiovascular events (cardiovascular death, myocardial infarction, and stroke). In univariate Cox proportional hazard regression analyses both biomarkers were predictors of events: the hazard ratio for log copeptin was 1.59 (95% CI 1.41-1.81; P < 0.001) and for log IGFBP-1 was 1.49 (1.26-1.77; P < 0.001). In the final model, adjusting for age and renal function, copeptin was the only independent predictor (1.35 [1.16-1.57]; P < 0.001).


CONCLUSIONS
Copeptin is an independent predictor of cardiovascular events and appears to at least partly explain the prognostic impact of IGFBP-1 in patients with type 2 diabetes and myocardial infarction. Copeptin may be a pathogenic factor to address to improve outcome in these patients.
Mellbin
Linda G
LG
Department of Medicine, Karolinska Institutet, Stockholm, Sweden. linda.mellbin@karolinska.se
Rydén
Lars
L
Brismar
Kerstin
K
Morgenthaler
Nils G
NG
Ohrvik
John
J
Catrina
Sergiu B
SB
D000368:Aged; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D018970:Insulin-Like Growth Factor Binding Protein 1 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000378:metabolism / Q000401:mortality*; D011237:Predictive Value of Tests; D011378:Prognathism; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D020521:Stroke / Q000378:metabolism / Q000401:mortality*
D006020:Glycopeptides; C032231:IGFBP1 protein, human; D018970:Insulin-Like Growth Factor Binding Protein 1; C048197:copeptins