Endocrine Abstracts

Background: Cardiovascular mortality is the leading cause of death in elderly people with diabetes. Traditional cardiovascular risk factors are not principal predictors for cardiovascular events in frail elderly.

Aim: This prospective study examined biomarkers associated with cardiovascular mortality in 253 community dwelling elderly aged 65 to 99 years. Patients were divided into four main groups: GROUP A-Patients with type 2 diabetes and history of MACE; GROUP B-Patients with type 2 diabetes, without MACE; GROUP C-Patients without diabetes, with MACE; GROUP D-Patients without diabetes and without MACE– the control group.

Methods: Patients were followed for a six months period. We checked medical records for presence of new MACE or cardiovascular death. MACE was defined as self-reported and medically documented myocardial infarction and/or stroke. Cardiovascular mortality was defined as mortality from myocardial infarction, heart failure, stroke, aneurism, or complications after vascular surgery. Baseline biochemical measurements were made from fasting blood samples performed at home on the morning of the baseline examination. We investigated traditional risk factors, inflammatory markers and albumin as marker of malnutrition. We also considered other standard biochemical measurements as potential risk factor. The associations between mortality risk and different biomarkers were assessed using Cox proportional hazards (PH) regression. We used cutoff points based on ROC analysis to form dichotomy variables from significant multivariable predictors. Differences in Kaplan-Meier survival curves were tested by Log rank test.

Results: Significant multivariate predictors for cardiovascular mortality were: albumin <40 g/l, BMI<25 kg/m², total bilirubin <10.5μmol/l, BUN≥6.5 mmol/l and hsCRP≥2.25 mg/l. We built the score system with these five predictors. The score was positive if someone had three or more of these five predictors positive and we called it inflammatory-malnutrition-renal involved score (IMRIS). Presence of prior MACE raised risk for cardiovascular mortality approximately twice (RR 2.113; P<0.001), and positive IMRIS nearly four times (RR 3.908; P<0.001). In group with T2D relative risk for cardiovascular mortality with positive IMRIS was 3.884 (P<0.001), vs.3.871 (P<0.001) in group without T2D. In group with prior MACE relative risk for cardiovascular mortality with positive IMRIS was 4.326 (P<0.001), vs.3.185 (P=0.001) in patients without MACE. In the control group low HDL-cholesterol was the only predictor for cardiovascular mortality (HDL≤ 1.51, RR 2.643; P=0.004). Conclusion In our study new proposed IMRIS score was predictive for cardiovascular mortality in patients with T2D regardless of traditional cardiovascular risk factors and metabolic control.