Antiphospholipid antibodies in patients with dysglycaemia: A neglected cardiovascular risk factor?

Giulia Ferrannini,Anna Norhammar,Kerstin Elvin,Elisabet Svenungsson,Barbro Kjellström,Lars Rydén,Giorgia Grosso,Per Näsman

doi:10.1177/1479164120922123

Giulia Ferrannini, Anna Norhammar + Show 6 more

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https://doi.org/10.1177/1479164120922123

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Abstract

Background:Cardiovascular disease is a serious complication in patients with dysglycaemia, defined as either type 2 diabetes or impaired glucose tolerance. Research focusing on the identification of potential markers for atherothrombotic disease in these subjects is warranted. The antiphospholipid syndrome is a common acquired prothrombotic condition, defined by a combination of thrombotic events and/or obstetric morbidity and positivity of specific antiphospholipid antibodies. Available information on antiphospholipid antibodies in dysglycaemia is scarce.Objective:This study investigates the association between antiphospholipid antibodies and dysglycaemia.Patients/Methods:The PAROKRANK (periodontitis and its relation to coronary artery disease) study included 805 patients, investigated 6–10 weeks after a first myocardial infarction, and 805 matched controls. Participants without known diabetes (91%) underwent an oral glucose tolerance test. Associations between antiphospholipid antibodies (anti-cardiolipin and anti-β2 glycoprotein-I IgG, IgM and IgA) and dysglycaemia were analysed.Results:In total, 137 (9%) subjects had previously known type 2 diabetes and 371 (23%) newly diagnosed dysglycaemia. Compared with the normoglycaemic participants, those with dysglycaemia had a higher proportion with first myocardial infarction (61% vs 45%, p < 0.0001) and were more often antiphospholipid antibody IgG positive (8% vs 5%; p = 0.013). HbA1c, fasting glucose and 2-h glucose were significantly associated to antiphospholipid antibody IgG. Odds ratios (ORs) were 1.04 (95% confidence interval [CI] 1.02–1.06), 1.14 (95% CI 1.00 – 1.27) and 1.12 (95% CI 1.04 – 1.21), respectively, after adjustments for age, gender and smoking.Conclusions:This study reports an association between antiphospholipid antibody IgG positivity and dysglycaemia. Further studies are needed to verify these findings and to investigate if antithrombotic therapy reduces vascular complications in antiphospholipid antibody positive subjects with dysglycaemia.

Highlights

Cardiovascular disease is a serious complication in patients with dysglycaemia, defined as either type 2 diabetes or impaired glucose tolerance
People with dysglycaemia, defined as either type 2 diabetes or impaired glucose tolerance (IGT), are at a two to four times higher risk for cardiovascular events compared with the general population and Cardiovascular disease (CVD) accounts for about 50% of all mortality in this patient group.[3,4]
This enhanced risk is primarily explained by the ‘common soil’ shared by CVD and dysglycaemia, which describes the clustering of vascular risk factors around insulin

Summary

Introduction

Cardiovascular disease is a serious complication in patients with dysglycaemia, defined as either type 2 diabetes or impaired glucose tolerance. Cardiovascular disease (CVD) is the leading global mortality cause, with the vast majority of deaths being related to the atherosclerotic vascular disease.[1,2] People with dysglycaemia, defined as either type 2 diabetes or impaired glucose tolerance (IGT), are at a two to four times higher risk for cardiovascular events compared with the general population and CVD accounts for about 50% of all mortality in this patient group.[3,4] This enhanced risk is primarily explained by the ‘common soil’ shared by CVD and dysglycaemia, which describes the clustering of vascular risk factors (endothelial dysfunction, increased platelet activity, suppression of fibrinolytic capacity, hyperglycaemia, dyslipidaemia and hypertension) around insulin.

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