Abstract
BackgroundThe association between TGF-β1 levels and long-term major adverse cardiovascular events (MACE) in patients with coronary artery disease (CAD) is controversial. No study specifically addressed patients with CAD and diabetes mellitus (DM). The association between TGF-β1 levels and long-term major adverse cardiovascular events (MACE) in patients with coronary artery disease (CAD) is controversial. No study specifically addressed patients with CAD and diabetes mellitus (DM).MethodsPatients (n = 135, 30–80 years) referred for coronary angiography were submitted to clinical and laboratory evaluation, and the coronary angiograms were evaluated by two operators blinded to clinical characteristics. CAD was defined as the presence of a 70% stenosis in one major coronary artery, and DM was characterized as a fasting glycemia > 126 mg/dl or known diabetics (personal history of diabetes or previous use of anti-hyperglycemic drugs or insulin). Based on these criteria, study patients were classified into four groups: no DM and no CAD (controls, C n = 61), DM without CAD (D n = 23), CAD without DM (C-CAD n = 28), and CAD with DM (D-CAD n = 23). Baseline differences between the 4 groups were evaluated by the χ2 test for trend (categorical variables) and by ANOVA (continuous variables, post-hoc Tukey). Patients were then followed-up during two years for the occurrence of MACE (cardiac death, stroke, myocardial infarction or myocardial revascularization). The association of candidate variables with the occurrence of 2-year MACE was assessed by univariate analysis.ResultsThe mean age was 58.2 ± 0.9 years, and 51% were men. Patients with CAD had a higher mean age (p = 0.011) and a higher percentage were male (p = 0.040). There were no significant baseline differences between the 4 groups regarding hypertension, smoking status, blood pressure levels, lipid levels or inflammatory markers. TGF-β1 was similar between patients with or without CAD or DM (35.1 ×/÷ 1.3, 33.6 ×/÷ 1.6, 33.9 ×/÷ 1.4 and 31.8 ×/÷ 1.4 ng/ml in C, D, C-CAD and D-CAD, respectively, p = 0.547). In the 2-year follow-ip, independent predictors of 2-year MACE were age (p = 0.007), C-reactive protein (p = 0.048) and systolic blood pressure (p = 0.008), but not TGF-β1.ConclusionSerum TGF-β1 was not associated with CAD or MACE occurrence in patients with or without DM.
Highlights
The association between TGF-β1 levels and long-term major adverse cardiovascular events (MACE) in patients with coronary artery disease (CAD) is controversial
Nikol et al demonstrated increased expression of TGF-β1 in human atherosclerotic plaques, and it was subsequently demonstrated that diabetic patients presenting with an acute myocardial infarction revealed decreased smooth muscle cells (SMCs), increased macrophages and TGF-β1 into the culprit lesion [8,9]
The aim of the present study is to evaluate the association between serum TGF-β1 and CAD in patients with diabetes mellitus (DM), and its influence in long-term MACE incidence
Summary
The association between TGF-β1 levels and long-term major adverse cardiovascular events (MACE) in patients with coronary artery disease (CAD) is controversial. No study addressed patients with CAD and diabetes mellitus (DM). Several risk factors are known to play a role in this intricate cascade, and diabetes mellitus (DM) is associated with a 3-fold increase in the risk of death or myocardial infarction due to coronary artery disease (CAD) [2]. A number of inflammatory cytokines mediate atherosclerosis, and TGF-β1 modulates important events like macrophage and fibroblast chemotaxis, suppression of lymphocyte function, collagen synthesis and stimulation of extracellular matrix synthesis [3,4,5,6,7]. Nikol et al demonstrated increased expression of TGF-β1 in human atherosclerotic plaques, and it was subsequently demonstrated that diabetic patients presenting with an acute myocardial infarction revealed decreased smooth muscle cells (SMCs), increased macrophages and TGF-β1 into the culprit lesion [8,9]
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