State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No 167 BeiLiShi Road, XiCheng District, Beijing, 100037, China.
Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Cardiovasc Diabetol. 2020 Feb 10;19(1):15. doi: 10.1186/s12933-020-0992-0.
Heart-type fatty acid-binding protein (H-FABP) is a novel marker of myocardial injury and has been reported to be associated with cardiovascular diseases (CVD) including patients with diabetes mellitus (DM). Unfortunately, its prognostic value in patients with CVD and impaired glucose metabolism (IGM) is unclear. The objective of this study was to investigate the prognostic value of H-FABP in CVD patients with IGM.
A total of 4594 patients with angiography-proven coronary artery disease (CAD) were enrolled and divided into subgroup according to glucose metabolism status (normal glucose regulation [NGR], pre-DM, and DM). Baseline levels of H-FABP were measured using latex immunoturbidimetric method. The cardiovascular events (CVE) were defined as cardiovascular death, myocardial infarction, stroke and coronary revascularization. Cox regression and Kaplan-Meier analysis were used to evaluate the relations of H-FABP and glucose metabolism status to CVEs.
During the follow-up period with up to 7.1 years, 380 CVEs occurred. Patients with CVE had higher levels of H-FABP compared to those without CVE (p < 0.001). Interestingly, H-FABP levels were also elevated in DM and pre-DM groups compared with NGR group (p < 0.001), when combined glucose metabolism status with H-FABP stratification, patients in the highest tertile of H-FABP appeared to have higher risk of CVEs with pre-DM (adjusted hazard ratio [HR]: 1.855, 95% confidential intervals [CIs] 1.076-3.214; p = 0.033) and DM (adjusted HR: 2.560, 95% CIs 1.409-4.650; p = 0.002). The Kaplan-Meier curve indicated that DM patients with the highest H-FABP levels were associated with the greatest risk of CVEs (p < 0.05).
Our data firstly showed that elevated H-FABP levels were associated with worse outcomes in CAD patients with pre-DM and DM, which provided the novel information that H-FABP might be a prognostic marker for clinical outcomes among patients with CAD and IGM.
心脏型脂肪酸结合蛋白（H-FABP）是一种新型心肌损伤标志物，已被报道与心血管疾病（CVD）相关，包括糖尿病（DM）患者。然而，其在伴有葡萄糖代谢异常（IGM）的 CVD 患者中的预后价值尚不清楚。本研究旨在探讨 H-FABP 在伴有 IGM 的 CVD 患者中的预后价值。
共纳入 4594 例经血管造影证实的冠心病（CAD）患者，并根据葡萄糖代谢状态（正常血糖调节[NGR]、糖尿病前期和 DM）分为亚组。使用乳胶免疫比浊法测定 H-FABP 的基线水平。心血管事件（CVE）定义为心血管死亡、心肌梗死、卒中和冠状动脉血运重建。Cox 回归和 Kaplan-Meier 分析用于评估 H-FABP 和葡萄糖代谢状态与 CVE 的关系。
在最长达 7.1 年的随访期间，发生了 380 例 CVE。发生 CVE 的患者 H-FABP 水平高于未发生 CVE 的患者（p<0.001）。有趣的是，DM 和糖尿病前期组的 H-FABP 水平也高于 NGR 组（p<0.001）。当结合 H-FABP 分层与葡萄糖代谢状态时，H-FABP 最高三分位的患者发生 CVE 的风险似乎更高，糖尿病前期（校正风险比[HR]：1.855，95%置信区间[CI]：1.076-3.214；p=0.033）和 DM（校正 HR：2.560，95%CI：1.409-4.650；p=0.002）。Kaplan-Meier 曲线表明，H-FABP 水平最高的 DM 患者发生 CVE 的风险最大（p<0.05）。
我们的数据首次表明，H-FABP 水平升高与伴有糖尿病前期和 DM 的 CAD 患者的不良预后相关，这提供了新的信息，即 H-FABP 可能是 CAD 和 IGM 患者临床结局的预后标志物。
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