Plasma YKL-40 predicts 10-year cardiovascular and all-cause mortality in individuals with type 2 diabetes.
OBJECTIVE
Elevated YKL-40 concentrations have been observed in both coronary heart disease (CHD) and diabetes. Thus, YKL-40 may play a role in pathogenesis of CHD in patients with diabetes. We evaluated whether plasma YKL-40 concentration can predict all-cause and cardiovascular mortality in individuals with type 2 diabetes.


METHODS
This is a prospective, observational study.


METHODS
A total of 628 subjects with type 2 diabetes were recruited between July 1996 and June 2003.


METHODS
Plasma YKL-40 concentrations were measured via enzyme-linked immunosorbent assay (ELISA). The cohort was followed up until 31 December 2008, when vital status and causes of death were obtained. Survival analysis and concordance statistics were performed. All-cause and cardiovascular mortalities were documented.


RESULTS
There were 153 (24·36%) mortalities, including 48 participants (7·64%) who died from cardiovascular diseases (CVDs). Participants with higher plasma YKL-40 (defined with a level above the median of 87·5 μg/l) had an increased risk of mortality. After adjusting for confounding variables, the hazard ratios (HR) for all-cause and cardiovascular mortality in participants with higher plasma YKL-40 were 1·97 (95% CI, 1·31-2·95, P < 0·01) and 2·45 (95% CI, 1·11-5·37, P < 0·05). The results remained similar after adjustment for age. Concordance statistics revealed that plasma YKL-40 concentration significantly increases the predictive power for both all-cause and cardiovascular mortality in different models.


CONCLUSIONS
Plasma YKL-40 concentration is an independent predictor of 10-year all-cause and cardiovascular mortality in subjects with type 2 diabetes. Further investigations on the role of YKL-40 in the pathogenesis of CVD are required to elucidate the underlying mechanisms.
Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliou City, Taiwan.
Chih-Hung
CH
Lin
Hung-Yuan
HY
Li
Yi-Der
YD
Jiang
Tien-Jyun
TJ
Chang
Lee-Ming
LM
Chuang
D054392:Adipokines / Q000097:blood*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000401:mortality*; D000071451:Chitinase-3-Like Protein 1; D003327:Coronary Disease / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000401:mortality*; D005260:Female; D006801:Humans; D037102:Lectins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology
D054392:Adipokines; D015415:Biomarkers; C084533:CHI3L1 protein, human; D000071451:Chitinase-3-Like Protein 1; D037102:Lectins