copeptin与患有和未患有糖尿病的老年男性发生中风、冠心病及心血管疾病死亡的风险：英国地区心脏研究
Copeptin and the risk of incident stroke, CHD and cardiovascular mortality in older men with and without diabetes: The British Regional Heart Study.
作者信息
Wannamethee S Goya, Welsh Paul, Lennon Lucy, Papacosta Olia, Whincup Peter H, Sattar Naveed
机构信息
Department of Primary Care and Population Health, UCL Medical School, Royal Free Campus, Rowland Hill St, London, NW3 2PF, UK.
Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
出版信息
Diabetologia. 2016 Sep;59(9):1904-12. doi: 10.1007/s00125-016-4011-7. Epub 2016 Jun 16.
AIMS/HYPOTHESIS: This study aimed to examine the association between copeptin (a surrogate marker of arginine vasopressin) and incident stroke, CHD and cardiovascular mortality in older men with and without diabetes.
METHODS
We conducted a prospective study of 3536 men aged 60-79 years who were followed for an average of 13 years. During this period, there were 437 major CHD events (fatal and non-fatal myocardial infarction [MI]), 323 stroke events (fatal and non-fatal) and 497 cardiovascular disease (CVD) deaths. Prevalent diabetes was defined on the basis of a history of doctor-diagnosed diabetes or fasting blood glucose ≥7.0 mmol or HbA1c ≥6.5% (48 mmol/mol) (n = 428).
RESULTS
No association was seen between copeptin and incident stroke or CVD mortality in men without diabetes after adjustment for conventional cardiovascular risk factors, renal dysfunction, and insulin and N-terminal pro B-type natriuretic peptide levels. In contrast, elevated copeptin levels were associated with an increased risk of stroke and CVD mortality in men with diabetes after these adjustments. Compared with those in the lowest tertile of copeptin, men in the top tertile had adjusted relative HRs for stroke and CVD death of 2.34 (95% CI 1.04, 5.27) and 2.21 (1.12, 4.36), respectively. The risk of stroke and CVD mortality remained increased after the exclusion of men with prevalent stroke or MI. Higher levels of copeptin were associated with increased risk of CHD in the diabetic and non-diabetic groups, but these associations were attenuated after exclusion of individuals with a previous stroke or MI.
CONCLUSIONS/INTERPRETATION: Copeptin was independently associated with an increased risk of incident stroke and CVD mortality in men with diabetes, but not in men without diabetes. Targeting the arginine vasopressin system might have beneficial effects on CVD mortality and stroke risk in older men with diabetes.
目的/假设：本研究旨在探讨在患有和未患糖尿病的老年男性中， copeptin（精氨酸加压素的替代标志物）与新发中风、冠心病及心血管疾病死亡率之间的关联。
方法
我们对3536名年龄在60 - 79岁的男性进行了一项前瞻性研究，平均随访13年。在此期间，发生了437例主要冠心病事件（致命和非致命心肌梗死[MI]）、323例中风事件（致命和非致命）以及497例心血管疾病（CVD）死亡。根据医生诊断的糖尿病病史或空腹血糖≥7.0 mmol或糖化血红蛋白≥6.5%（48 mmol/mol）定义糖尿病患病率（n = 428）。
结果
在调整了传统心血管危险因素、肾功能不全、胰岛素及N末端B型利钠肽前体水平后，未患糖尿病男性的copeptin与新发中风或CVD死亡率之间未发现关联。相比之下，在进行这些调整后，患有糖尿病男性的copeptin水平升高与中风和CVD死亡率风险增加相关。与copeptin最低三分位数组的男性相比，最高三分位数组的男性中风和CVD死亡的校正相对风险分别为2.34（95% CI 1.04, 5.27）和2.21（1.12, 4.36）。排除患有中风或MI的男性后，中风和CVD死亡率风险仍然增加。copeptin水平较高与糖尿病组和非糖尿病组的冠心病风险增加相关，但在排除既往有中风或MI的个体后，这些关联减弱。
结论/解读：Copeptin与患有糖尿病男性的新发中风和CVD死亡率风险增加独立相关，但与未患糖尿病男性无关。针对精氨酸加压素系统可能对患有糖尿病的老年男性的CVD死亡率和中风风险产生有益影响。
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