title: Proinsulin and IGFBP-1 predicts mortality in an elderly population.
abstract: BACKGROUND
  High IGFBP-1 in elderly subjects is related to all-cause and cardiovascular (CV) mortality. We studied the relation of IGFBP-1 to cardiometabolic risk factors and cardiovascular and all-cause mortality, and also the impact of proinsulin and insulin on this association in an unselected elderly primary health care population.
  
  
  OBJECTIVE
  Our hypothesis was that proinsulin and insulin may have an impact on the association of high IGFBP-1 levels with all-cause and CV-mortality in elderly.
  
  
  METHODS
  A cross-sectional and prospective study was carried out in a rural Swedish population. 851 persons aged 66-81 years were evaluated by medical history, clinical examination, electrocardiography, echocardiography, and fasting plasma samples, and were followed prospectively for up to 12 years.
  
  
  RESULTS
  At baseline, in a multivariate analysis, IGFBP-1 was associated with gender, N-terminal proBNP (NT pro-BNP), blood glucose, body mass index (BMI), insulin and proinsulin, estimated glomerular filtration rate (eGFR) and haemoglobin (Hb). During the follow-up period there were 230 deaths (27%), of which 134 (16%) were due to CV mortality. When divided into tertiles there was a significant difference for CV mortality and all-cause mortality between tertiles of IGFBP-1 and proinsulin. For insulin there was a significant difference only for all-cause mortality. After adjustment for well-known risks factors, proinsulin and IGFBP-1 had significant impact on all-cause mortality but only proinsulin on CV mortality.
  
  
  CONCLUSIONS
  Only proinsulin is an independent predictor for both all-cause mortality and CV mortality when comparing IGFBP-1, insulin, and proinsulin as prognostic biomarkers for CV and all-cause mortality in an elderly population.
authors.affiliation: Department of Acute Healthcare, County Council of Östergötland, Linköping, Cell Biology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Sweden. Electronic address: ioana.simona.chisalita@liu.se.
authors.forename: Simona I
authors.initials: SI
authors.lastname: Chisalita
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Department of Cardiology UHL, County Council of Östergötland, Linköping, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Dahlström
authors.affiliation: Cell Biology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Department of Endocrinology and Gastroenterology UHL, County Council of Östergötland, Linköping, Sweden.
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Arnqvist
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Department of Cardiology UHL, County Council of Östergötland, Linköping, Sweden.
authors.forename: Urban
authors.initials: U
authors.lastname: Alehagen
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality*; D002423:Cause of Death; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood*; D018970:Insulin-Like Growth Factor Binding Protein 1 / Q000097:blood*; D008297:Male; D008659:Metabolic Diseases / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D011384:Proinsulin / Q000097:blood*; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D007328:Insulin; D018970:Insulin-Like Growth Factor Binding Protein 1; D011384:Proinsulin
keywords: Elderly population; Insulin; Insulin-like growth factor binding protein-1; Proinsulin