title: Copeptin in patients with acute myocardial infarction and newly detected glucose abnormalities - A marker of increased stress susceptibility? A report from the Glucose in Acute Myocardial Infarction cohort.
abstract: To characterize copeptin levels and to explore its prognostic importance in patients with acute myocardial infarction with newly detected glucose abnormalities.
  
  
  
  Copeptin was measured in 166 patients with acute myocardial infarction without known diabetes and in 168 age- and gender-matched controls. Participants were classified as having normal glucose tolerance or abnormal glucose tolerance (impaired glucose tolerance + type 2 diabetes mellitus) by oral glucose tolerance test. Study participants were followed over a decade for major cardiovascular event (acute myocardial infarction/stroke/congestive heart failure/cardiovascular death), cardiovascular and total death.
  
  
  
  Median copeptin level was higher in patients (10.5 pmol/L) than controls (5.9 pmol/L; p < 0.01). Patients with abnormal glucose tolerance had higher copeptin (12.2 pmol/L) than those with normal glucose tolerance (7.9 pmol/L; p < 0.01) but levels of copeptin did not differ in controls with abnormal glucose tolerance or normal glucose tolerance. Copeptin predicted major cardiovascular events [ n = 64; hazard ratio = 1.15 (1.01-1.32; p = 0.04)], cardiovascular mortality [ n = 29; hazard ratio = 1.24 (1.06-1.46; p = 0.01)] and total death [ n = 51; hazard ratio = 1.21 (1.05-1.40; p = 0.01)] in unadjusted Cox regression analyses in the patient cohort. In controls, copeptin predicted major cardiovascular events [ n = 26; hazard ratio = 1.17 (1.01-1.36; p = 0.03)].
  
  
  
  Copeptin levels are highest among acute myocardial infarction patients with glucose disturbances and predict an adverse prognosis in unadjusted analyses. These findings imply that raised copeptin reflects stress rather than acting as a pathogenic factor for glucose abnormalities.
authors.affiliation: 1 Cardiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: Smaradottir
authors.affiliation: 1 Cardiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.|2 Department of Research and Development, Region Kronoberg, Växjö, Sweden.
authors.forename: Viveca
authors.initials: V
authors.lastname: Ritsinger
authors.affiliation: 1 Cardiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.|3 Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
authors.forename: Viveca
authors.initials: V
authors.lastname: Gyberg
authors.affiliation: 1 Cardiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Norhammar
authors.affiliation: 4 Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Näsman
authors.affiliation: 1 Cardiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Linda G
authors.initials: LG
authors.lastname: Mellbin
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D005260:Female; D018149:Glucose Intolerance / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D005951:Glucose Tolerance Test; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D013312:Stress, Physiological; D013548:Sweden; D013997:Time Factors; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006020:Glycopeptides; C048197:copeptins
keywords: Diabetes mellitus; acute coronary syndrome; arginine vasopressin; biomarker; copeptin; prognosis