Data on the impact of peripheral artery disease and of type 2 diabetes mellitus on the risk of cardiovascular events.

Here, we provide additional data addressing the individual and combined associations of type 2 diabetes (T2DM) and of peripheral artery disease (PAD) with future cardiovascular events in a prospective cohort study including 338 PAD patients and 711 patients who did not have PAD. Subgroup analyses regarding patient age as well as additional Cox regression models taking into account medications are presented. This data article is related to a research article titled "Single and combined effects of peripheral artery disease and of type 2 diabetes mellitus on the risk of cardiovascular events: a prospective cohort study" (Saely et al., 2018).

Single and combined effects of peripheral artery disease and of type 2 diabetes mellitus on the risk of cardiovascular events: A prospective cohort study.

BACKGROUND AND AIMS: The individual and combined effects of type 2 diabetes (T2DM) and peripheral artery disease (PAD) on future cardiovascular events are unknown and are addressed in the present investigation. METHODS: Cardiovascular events were prospectively recorded in 1049 subjects, encompassing 4 groups: 558 with neither PAD nor diabetes, 153 with T2DM but without PAD, 192 with PAD but without T2DM and 146 with the combination of PAD and T2DM. RESULTS: Over a mean follow-up period of 7.2 ±â€¯2.6 years, the cardiovascular event rate was lowest in patients with neither PAD nor T2DM (16.7%). Compared to this group the event rate was not significantly increased in T2DM patients without PAD (22.2%, p = 0.077) but higher in non-diabetic patients with PAD (52.6%; p < 0.001) and further increased in patients with both PAD and T2DM (71.2%; p < 0.001). Nondiabetic PAD patients were at a higher cardiovascular risk than T2DM patients without PAD (p < 0.001). Compared to those with neither PAD nor T2DM, hazard ratios after multivariate adjustment were 1.26 [0.84-1.91]; p = 0.267, 4.17 [2.97-5.85]; p < 0.001, and 7.82 [5.49-11.12]; p < 0.001 for those with T2DM only, for those with PAD only and for those with the combination of PAD plus diabetes, respectively. CONCLUSIONS: PAD is a stronger risk factor for future cardiovascular events than T2DM, but T2DM in PAD patients accelerates atherothrombotic disease and strongly increases the incidence of cardiovascular events.

Lipoprotein (a), the Metabolic Syndrome and Vascular Risk in Angiographied Coronary Patients.

BACKGROUND: Lipoprotein (a) [Lp(a)] especially in young individuals, is an important cardiovascular risk factor. However, data on the vascular risk conferred by Lp(a) in patients with the metabolic syndrome (MetS) are not available. METHODS: Lp(a) was measured in a cohort of 593 consecutive patients undergoing coronary angiography for the evaluation of stable coronary artery disease. MetS was diagnosed according to International Diabetes Federation criteria. Vascular events were recorded over 10 years. RESULTS: Median Lp(a) was significantly lower in patients with the MetS (n = 307) than in subjects who did not have the MetS (12 [interquartile range, 0-35] mg/dl vs 17 [0-57] mg/dl; P = .004). Prospectively, 34% of our patients suffered vascular events. Lp(a) proved to be a strong and independent predictor of vascular events in subjects without the MetS (standardized adjusted hazard ratio [HR], 1.20 [1.05-1.38]; P = .006) but not in patients who had the MetS (HR, 0.96 [0.77-1.20]; P = .713). An interaction term MetS × Lp(a) was significant (P = .029), indicating that Lp(a) was a significantly stronger predictor of vascular events in subjects without the MetS than in patients with the MetS. CONCLUSIONS: Lp(a) in patients with the MetS is low and is not associated with the incidence of vascular events. The power of Lp(a) as a predictor of cardiovascular events is significantly modulated by the presence of the MetS.

Common single nucleotide polymorphisms at the NPC1L1 gene locus significantly predict cardiovascular risk in coronary patients.

BACKGROUND: Niemann-Pick C1-like 1 (NPC1L1) is involved in dietary cholesterol absorption and is the direct molecular target of the LDL-lowering drug ezetimibe. Recently, genetic variants in NPC1L1 have been associated with the incidence of cardiovascular events, but it remains unclear if the impact of NPC1L1 on cardiovascular risk is dependent on its role in cholesterol absorption. Furthermore, no direct association of genetic variants in NPC1L1 with coronary atherosclerosis has been established. METHODS: To further address these issues, we determined the impact of 34 single nucleotide polymorphisms (SNPs) at the NPC1L1 gene locus on the presence of coronary atherosclerosis and prospectively on future cardiovascular events in a cohort of 984 angiographied Caucasian patients. RESULTS: Out of investigated SNPs, 24 variants were significantly associated with future cardiovascular events. The highest impact was observed for rs55837134 (sex-and age adjusted additive HR = 1.67 [1.28-2.18]; p = 1.3 e-4). Regression analysis conditioned on rs55837134 showed that significant associations between remaining SNPs at the NPC1L1 locus and vascular events did not persist suggesting their dependence on rs55837134. Its significant association remained almost unchanged after further adjustment for total cholesterol, LDL cholesterol, and other cardiovascular risk factors (additive HR = 1.67 [1.28-2.18]; p = 1.7 e-4). In addition, no significant association of investigated NPC1L1 variants with coronary atherosclerosis could be observed, at least after false discovery rate correction. CONCLUSIONS: Genetic variants of NPC1L1, particularly rs55837134, show a predictive impact on cardiovascular events. Further studies to determine the molecular consequences of common genetic variants in NPC1L1 are needed.

Angiopoietin-like protein 4 significantly predicts future cardiovascular events in coronary patients.

BACKGROUND: Angiopoietin-like protein 4 (ANGPTL4) has been associated with cardiometabolic disorders including dyslipidemia and atherosclerosis in animal studies; in humans, however, its impact on metabolic traits and cardiovascular risk remains unclear. METHODS: We examined the association of plasma ANGPTL4 levels with the metabolic syndrome (harmonized consensus definition), with angiographically determined coronary artery disease (CAD), and with the risk of future cardiovascular events in a cohort of 490 patients undergoing coronary angiography for the evaluation of stable CAD. In addition, we investigated the influence of the tagging single nucleotide polymorphisms (SNPs) rs4076317, rs2278236, rs1044250, and rs11672433 as well as variant rs116843064 (E40K) of the ANGPTL4 gene on cardiovascular risk in a larger sample of 983 angiographied coronary patients including the above mentioned 490 subjects. RESULTS: Plasma ANGPTL4 was significantly higher in patients with the metabolic syndrome than in subjects without the metabolic syndrome (26.0 ± 19.4 ng/ml vs. 22.2 ± 19.7 ng/ml; p = 0.008). No significant association was found between ANGPTL4 and angiographically characterized coronary atherosclerosis. Prospectively, however, plasma ANGPTL4 significantly predicted future cardiovascular events both univariately (HR1.45 [1.16-1.82], p = 0.001) and after adjustment for standard cardiovascular risk factors (1.26 [1.01-1.58]; p = 0.045). Concordantly, rs4076317, rs2278236, and rs1044250 significantly affected the risk of future cardiovascular events (adjusted HRs 0.70 [0.54-0.90]; p = 0.005, 0.76 [0.61-0.94]; p = 0.012, and 1.30 [1.03-1.62]; p = 0.025, respectively). CONCLUSIONS: We conclude that plasma ANGPTL4 levels as well as ANGPTL4 variants significantly predict cardiovascular events independently of conventional cardiovascular risk factors.