OBJECTIVE

The present study characterizes mannose-binding lectin (MBL), an activator of the complement system and thereby important for inflammatory activation, in patients with diabetes and myocardial infarction.

RESEARCH DESIGN AND METHODS

Serum (S)-MBL was determined at hospital admission in 387 patients with type 2 diabetes (median age 70 years; 68% male) with myocardial infarction, and genotyping was performed in 287 patients. Cardiovascular events (cardiovascular mortality and nonfatal myocardial infarction or stroke) were recorded during 2.5 years.

RESULTS

Median S-MBL was 1,212 μg/l (interquartile range [IQR] 346–2,681 μg/l). Of the subjects, 54% in the geno- and phenotype subgroup had a high-coding MBL genotype (median S-MBL = 2,658 μg/l [IQR 1,715–3,829]) and 46% a low-coding MBL genotype (373 μg/l [100–765]). S-MBL did not correlate with age, BMI, creatinine clearance, glucose, or A1C. Cardiovascular events occurred in 136 (35%) patients. S-MBL did not predict events in univariable analyses (hazard ratio 0.93 [95% CI 0.85–1.01]; P = 0.09). In unadjusted analyses, the risk of events was lower in patients with a high genotype and S-MBL above the median for their genotype (0.49 [0.26–0.92]; P = 0.026) than for patients with a low genotype and S-MBL below the median for their genotype. The prediction capacity of the geno- and phenotype model was of borderline significance in adjusted Cox regression.

CONCLUSIONS

Patients with type 2 diabetes and myocardial infarction have MBL genotypes that are similar to those known in the general population. The combination of a low-coding MBL genotype with a low S-MBL appears to be prognostically unfavorable, but the association is blunted by traditional risk markers.

OBJECTIVE

To determine whether C-terminal provasopressin (copeptin) explains the prognostic importance of insulin growth factor binding protein-1 (IGFBP-1) in patients with myocardial infarction and type 2 diabetes.

RESEARCH DESIGN AND METHODS

Copeptin and IGFBP-1 were analyzed in 393 patients participating in the Diabetes Mellitus Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) 2 trial.

RESULTS

Copeptin was associated with IGFBP-1 (Spearman rank correlation test, r = 0.53; P < 0.001). During follow-up there were 138 cardiovascular events (cardiovascular death, myocardial infarction, and stroke). In univariate Cox proportional hazard regression analyses both biomarkers were predictors of events: the hazard ratio for log copeptin was 1.59 (95% CI 1.41–1.81; P < 0.001) and for log IGFBP-1 was 1.49 (1.26–1.77; P < 0.001). In the final model, adjusting for age and renal function, copeptin was the only independent predictor (1.35 [1.16–1.57]; P < 0.001).

CONCLUSIONS

Copeptin is an independent predictor of cardiovascular events and appears to at least partly explain the prognostic impact of IGFBP-1 in patients with type 2 diabetes and myocardial infarction. Copeptin may be a pathogenic factor to address to improve outcome in these patients.

In a representative sample of 895 schoolchildren, aged between 9 years 10 months and 11 years 2 months, the risk of being overweight or obese was compared between those who had gained weight rapidly during infancy and those whose weight gain had been normal. A substantially increased risk ratio was found only in boys for whom a correlation analysis showed that the total weight gain during the first year of life was associated with the total body mass in relation to height, more or less independently of the degree of fatness at 10 1/2 years of age. In girls, a direct but very weak association was found between weight gain in infancy and the degree of fatness at 10 1/2 years. The implications of these findings with respect to aetiology and the possibilities of prevention are briefly discussed.

Heights and weights were measured in 963 10-year-old children, whose weight data from the first year of life were available. Rapid weight gain in infancy was arbitrarily defined on the basis of sex-specific percentiles of weight gain at four-month intervals and from birth to 12 months. In girls, no significant association between rapid weight gain in infancy and overweight at 10 1/2 years was found. In boys, the association was significant for severe overweight (greater than 120% of standard weight for height). An estimation of the possible benefit of an intervention programme (food restriction in all male infants with rapid weight gain) showed, however, that at the very best 12% of the boys treated in this way could be expected to gain some benefit. The result of a correlation analysis between weight gain in infancy and change in height and relative weight between 7 and 10 1/2 years suggested that the factors which determined weight gain in infancy were no longer operative at ages between 7 and 10 1/2 years.