title: Plasma norepinephrine is an independent predictor of adverse cerebral and cardiovascular events in type 2 diabetic patients without structural heart disease.
abstract: BACKGROUND
  Resting plasma norepinephrine (NE) level was reportedly related to high mortality in patients with heart failure. The current study investigated whether resting NE could predict long-term major adverse cerebral and cardiovascular events (MACCEs) in Japanese type 2 diabetic patients without heart disease.
  
  
  METHODS
  We evaluated resting NE in 95 patients with type 2 diabetes who did not have severe complications. Based on the ROC curves, high NE was defined as ≥333pg/ml. Accurate follow-up information during a mean of 3.6±1.9 years was obtained in 27 high NE patients (13 female, mean age 64±12 years) and 68 low NE patients (29 female, 60±12 years).
  
  
  RESULTS
  The Kaplan-Meier curves revealed that MACCE-free ratio was significantly lower in the high NE patients than in the low NE patients (log-rank 10.3, p=0.0013). Cox proportional hazards regression analysis revealed that female gender (hazard ratio 7.75), low baroreflex sensitivity (hazard ratio 6.66), and high NE (hazard ratio 5.40) were independently associated with the incidence of MACCE.
  
  
  CONCLUSIONS
  Our results suggest that resting NE is comparably useful to identify the high-risk patients for MACCE to baroreflex sensitivity in type 2 diabetic patients. The results also suggest that pathogenic sympathetic activation leading to MACCE may be identified by the assessment of resting NE, more easily and less expensively compared to cardiac iodine 123 metaiodobenzylguanidine scintigraphy in this population.
authors: Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Oita, Japan. Electronic address: yufukuni@oita-u.ac.jp.
authors: Kunio
authors: K
authors: Yufu
authors: Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Oita, Japan.
authors: Norihiro
authors: N
authors: Okada
authors: Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Oita, Japan.
authors: Yuki
authors: Y
authors: Ebata
authors: Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Oita, Japan.
authors: Yukichi
authors: Y
authors: Murozono
authors: Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Oita, Japan.
authors: Tetsuji
authors: T
authors: Shinohara
authors: Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Oita, Japan.
authors: Mikiko
authors: M
authors: Nakagawa
authors: Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Oita, Japan.
authors: Naohiko
authors: N
authors: Takahashi
mesh_terms: D000368:Aged; D017704:Baroreflex; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005500:Follow-Up Studies; D005544:Forecasting; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood*; D016016:Proportional Hazards Models; D012372:ROC Curve; D012146:Rest / Q000502:physiology*; D012306:Risk; D018570:Risk Assessment; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology*; D013997:Time Factors
chemical_list: D015415:Biomarkers; D009638:Norepinephrine
keywords: Autonomic nervous system; Cardiovascular event; Diabetes mellitus; Norepinephrine