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OP34 A MODIFIED RISK EQUATION FOR DEVELOPMENT OF CORONARY HEART DISEASE IN HONG KONG CHINESE WITH TYPE 2 DIABETES
Oral presentation abstracts / Diabetes Research and Clinical Practice 106S1 (2014) S1–S41
Conclusion: These findings collectively suggest that serum 25(OH)D3 levels were inversely associated with atherosclerosis in Chinese middle-aged and elderly men. OP33 LOWER HDL CHOLESTEROL IS ASSOCIATED WITH THE RISK OF STROKE IN DIABETIC INDIVIDUALS WITH POOR GLYCEMIC CONTROL: 5.5-YEAR SURVEY OF CARDIOVASCULAR EVENTS K. Ina1 , T. Hayashi1 , M. Kuzuya1 . 1 Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan Background: The aim of this study was to identify factors that predict ischemic heart disease (IHD) or cerebrovascular accident (CVA) in diabetic individuals and to investigate their differences by age. We investigated the relationship between lipid levels and IHD and CVA in diabetic individuals according to glycated hemoglobin (HbA1c, 7.9% or < 7.9%). Method: We performed a prospective cohort study (Japan Cholesterol and Diabetes Mellitus Study) with 5.5 years of follow-up. A total of 4,014 patients with type 2 diabetes (1,936 women; age 67.4±9.5 years, median 70 years; < 65 years old, n = 1,261; 65 to 74 years old, n = 1,731; and 75 years old, n = 1,016) were recruited on a consecutive outpatient basis from 40 hospitals throughout Japan. Patients with coronary artery disease, which was defined as previous myocardial infarction, coronary intervention, or confirmed angina pectoris and recent stroke, who had been admitted within the past 24 months were excluded. The primary end points were onset of IHD or CVA. Lipids, glucose and other factors related to IHD or CVA risk were investigated. Result: The diabetic participants were divided into those who were aged < 65 years, 65–74 years and 75 years. 153 cases of IHD and 104 cases of CVA (7.8 and 5.7/1,000 people per year, respectively) occurred over 5.5 years. Lipid and glucose levels and other factors were investigated in relation to the occurrence of IHD or CVA. In this study, we focused on HbA1c levels. HDL-cholesterol (HDL-C) was significantly associated with risk of CVA in diabetic individuals with poor glycemic control (HbA1c 7.9%) who were aged < 65 years. Triglyceride (TG) was significantly associated with risk of CVA in diabetic individuals with poor glycemic control (HbA1c 7.9%) who were aged 75 years. HDL-C, LDL-cholesterol (LDL-C) and TG were not significantly associated with risk of CVA in diabetic individuals (HbA1c < 7.9%). HDL-C, LDL-C and TG were not significantly associated with risk of IHD in diabetic individuals (HbA1c, 7.9% and < 7.9%). Risk factors for cardiovascular events appear to change with advancing age. The importance of HDL-C is different for each age-group. Conclusion: Lower HDL-C was an important risk factor for CVA in diabetic individuals with poor glycemic control who were aged < 65 years. This result is important for developing individualized strategies to prevent atherosclerotic disease. OP34 A MODIFIED RISK EQUATION FOR DEVELOPMENT OF CORONARY HEART DISEASE IN HONG KONG CHINESE WITH TYPE 2 DIABETES E. Lau1 , W.Y. So1,2,3 , R.C.W. Ma1,2,3 , R. Ozaki1,2,3 , A.P.S. Kong1,2,3 , R. Wong1,3 , W. Lau1,3 , K. Cheung1,3 , R. Ting1,3 , E. Wu1,3 , D. Chan1,3 , T. Yau1,3 , G. Ko1,2,3 , C.C. Chow1,2,3 , J.C.N. Chan1,2,3 , A. Luk1,2,3 . 1 Department of Medicine and Therapeutics, 2 Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, 3 Diabetes and Endocrine Centre, Prince of Wales Hospital, Shatin, Hong Kong Background: We previously developed a risk equation to predict coronary heart disease (CHD) in Hong Kong Chinese patients with Type 2 diabetes (Yang X et al. Am J Cardiology 2008). However the inclusion of albuminuria precluded its generalized application especially in low-to-middle-income areas. In this expanded cohort, we used clinical assessments
S17
and common laboratory tests to develop a simpler risk equation. Method: The Hong Kong Diabetes Registry is a prospective cohort of Hong Kong Chinese patients with Type 2 diabetes established by the Diabetes Centre at the Prince of Wales Hospital as a quality improvement program since 1995. All patients underwent periodic structured assessments every 18–24 months including history taking, clinical measurements, eye/feet examination and blood/urine tests. Development of complications were censored in 31 January 2009 using the Hong Kong Hospital Authority territorywide electronic Clinical Management System based on International Classification Codes (ICD-9). The patients were assigned randomly to a training set and a testing set in the ratio of 3: 1. Patients with history of coronary heart disease (CHD) at baseline or incomplete data were excluded. The risk equation was developed using the Cox proportional hazard regression by the training set. Non-linear relations between the CHD and risk factors were examined by restricted cubic splines. The initial risk factors included age, duration of diabetes, gender, history of smoking, HbA1c , systolic blood pressure (SBP), high density-lipoprotein cholesterol (HDL-C), low density-lipoprotein cholesterol (LDL-C), triglyceride, estimate glomerular filtration rate (eGFR) and history of diabetic complications, including peripheral vascular disease (PVD), congestive heart failure (CHF) and stroke. These risk factors were chosen by backward stepwise selection with Bayesian information criterion (BIC) as the selection criterion. The final risk equation was evaluated by the concordanceindex of the testing set. Result: We included 8296 patients with a median follow-up period of 7.2 (IQR: 3.7–10.7) years and 502 incident cases of CHD. Using backward stepwise selection method, age, duration of diabetes, history of smoking, SBP, HDL-C, LDL-C, eGFR, history of PVD and history of CHF were selected as independent predictors in the final model. Non-linear relations were found between CHD and age, duration of diabetes and eGFR. The concordance-index of training set and testing set were 0.736 and 0.757 respectively. Conclusion: We developed a risk equation for incident CHD using commonly available clinical factors, with moderate performance as shown by the concordance-index. The dependence of CHD on the history of PVD and CHF also indicated the close links amongst different diabetic complications. OP35 SERUM LIPOCALIN-2 LEVELS POSITIVELY CORRELATE WITH CORONARY ARTERY DISEASE AND METABOLIC SYNDROME J. Ni1 , X.J. Ma1 , M. Zhou1 , X.P. Pan1 , J.L. Tang1 , Y.P. Hao1 , Z.G. Lu2 , M.F. Gao2 , Y.Q. Bao1 , W.P. Jia1 . 1 Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Diabetes Institute, 2 Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China Background: The lipocalin-2 cytokine, primarily known as a protein of the granules of human neutrophils, has been recently reported to be implicated in metabolic and inflammatory disorders. This study was designed to evaluate the relationship between serum lipocalin-2 levels, coronary artery disease (CAD) and metabolic syndrome (MS). Method: Serum lipocalin-2 levels of 261 in-patients who underwent coronary angiography were measured by sandwich enzyme immunoassay. Demographic (169 men and 92 postmenopausal women) and clinical (metabolic syndrome (MS), triglyceride (TG) and C-reactive protein (CRP) levels) characteristics were collected to assess independent factors of CAD (CAD: 188 and non-CAD: 73) and serum lipocalin-2 levels by multiple logistic regression and multivariate stepwise regression analyses, respectively.
Conclusion: These findings collectively suggest that serum 25(OH)D3 levels were inversely associated with atherosclerosis in Chinese middle-aged and elderly men. OP33 LOWER HDL CHOLESTEROL IS ASSOCIATED WITH THE RISK OF STROKE IN DIABETIC INDIVIDUALS WITH POOR GLYCEMIC CONTROL: 5.5-YEAR SURVEY OF CARDIOVASCULAR EVENTS K. Ina1 , T. Hayashi1 , M. Kuzuya1 . 1 Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan Background: The aim of this study was to identify factors that predict ischemic heart disease (IHD) or cerebrovascular accident (CVA) in diabetic individuals and to investigate their differences by age. We investigated the relationship between lipid levels and IHD and CVA in diabetic individuals according to glycated hemoglobin (HbA1c, 7.9% or < 7.9%). Method: We performed a prospective cohort study (Japan Cholesterol and Diabetes Mellitus Study) with 5.5 years of follow-up. A total of 4,014 patients with type 2 diabetes (1,936 women; age 67.4±9.5 years, median 70 years; < 65 years old, n = 1,261; 65 to 74 years old, n = 1,731; and 75 years old, n = 1,016) were recruited on a consecutive outpatient basis from 40 hospitals throughout Japan. Patients with coronary artery disease, which was defined as previous myocardial infarction, coronary intervention, or confirmed angina pectoris and recent stroke, who had been admitted within the past 24 months were excluded. The primary end points were onset of IHD or CVA. Lipids, glucose and other factors related to IHD or CVA risk were investigated. Result: The diabetic participants were divided into those who were aged < 65 years, 65–74 years and 75 years. 153 cases of IHD and 104 cases of CVA (7.8 and 5.7/1,000 people per year, respectively) occurred over 5.5 years. Lipid and glucose levels and other factors were investigated in relation to the occurrence of IHD or CVA. In this study, we focused on HbA1c levels. HDL-cholesterol (HDL-C) was significantly associated with risk of CVA in diabetic individuals with poor glycemic control (HbA1c 7.9%) who were aged < 65 years. Triglyceride (TG) was significantly associated with risk of CVA in diabetic individuals with poor glycemic control (HbA1c 7.9%) who were aged 75 years. HDL-C, LDL-cholesterol (LDL-C) and TG were not significantly associated with risk of CVA in diabetic individuals (HbA1c < 7.9%). HDL-C, LDL-C and TG were not significantly associated with risk of IHD in diabetic individuals (HbA1c, 7.9% and < 7.9%). Risk factors for cardiovascular events appear to change with advancing age. The importance of HDL-C is different for each age-group. Conclusion: Lower HDL-C was an important risk factor for CVA in diabetic individuals with poor glycemic control who were aged < 65 years. This result is important for developing individualized strategies to prevent atherosclerotic disease. OP34 A MODIFIED RISK EQUATION FOR DEVELOPMENT OF CORONARY HEART DISEASE IN HONG KONG CHINESE WITH TYPE 2 DIABETES E. Lau1 , W.Y. So1,2,3 , R.C.W. Ma1,2,3 , R. Ozaki1,2,3 , A.P.S. Kong1,2,3 , R. Wong1,3 , W. Lau1,3 , K. Cheung1,3 , R. Ting1,3 , E. Wu1,3 , D. Chan1,3 , T. Yau1,3 , G. Ko1,2,3 , C.C. Chow1,2,3 , J.C.N. Chan1,2,3 , A. Luk1,2,3 . 1 Department of Medicine and Therapeutics, 2 Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, 3 Diabetes and Endocrine Centre, Prince of Wales Hospital, Shatin, Hong Kong Background: We previously developed a risk equation to predict coronary heart disease (CHD) in Hong Kong Chinese patients with Type 2 diabetes (Yang X et al. Am J Cardiology 2008). However the inclusion of albuminuria precluded its generalized application especially in low-to-middle-income areas. In this expanded cohort, we used clinical assessments
S17
and common laboratory tests to develop a simpler risk equation. Method: The Hong Kong Diabetes Registry is a prospective cohort of Hong Kong Chinese patients with Type 2 diabetes established by the Diabetes Centre at the Prince of Wales Hospital as a quality improvement program since 1995. All patients underwent periodic structured assessments every 18–24 months including history taking, clinical measurements, eye/feet examination and blood/urine tests. Development of complications were censored in 31 January 2009 using the Hong Kong Hospital Authority territorywide electronic Clinical Management System based on International Classification Codes (ICD-9). The patients were assigned randomly to a training set and a testing set in the ratio of 3: 1. Patients with history of coronary heart disease (CHD) at baseline or incomplete data were excluded. The risk equation was developed using the Cox proportional hazard regression by the training set. Non-linear relations between the CHD and risk factors were examined by restricted cubic splines. The initial risk factors included age, duration of diabetes, gender, history of smoking, HbA1c , systolic blood pressure (SBP), high density-lipoprotein cholesterol (HDL-C), low density-lipoprotein cholesterol (LDL-C), triglyceride, estimate glomerular filtration rate (eGFR) and history of diabetic complications, including peripheral vascular disease (PVD), congestive heart failure (CHF) and stroke. These risk factors were chosen by backward stepwise selection with Bayesian information criterion (BIC) as the selection criterion. The final risk equation was evaluated by the concordanceindex of the testing set. Result: We included 8296 patients with a median follow-up period of 7.2 (IQR: 3.7–10.7) years and 502 incident cases of CHD. Using backward stepwise selection method, age, duration of diabetes, history of smoking, SBP, HDL-C, LDL-C, eGFR, history of PVD and history of CHF were selected as independent predictors in the final model. Non-linear relations were found between CHD and age, duration of diabetes and eGFR. The concordance-index of training set and testing set were 0.736 and 0.757 respectively. Conclusion: We developed a risk equation for incident CHD using commonly available clinical factors, with moderate performance as shown by the concordance-index. The dependence of CHD on the history of PVD and CHF also indicated the close links amongst different diabetic complications. OP35 SERUM LIPOCALIN-2 LEVELS POSITIVELY CORRELATE WITH CORONARY ARTERY DISEASE AND METABOLIC SYNDROME J. Ni1 , X.J. Ma1 , M. Zhou1 , X.P. Pan1 , J.L. Tang1 , Y.P. Hao1 , Z.G. Lu2 , M.F. Gao2 , Y.Q. Bao1 , W.P. Jia1 . 1 Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Diabetes Institute, 2 Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China Background: The lipocalin-2 cytokine, primarily known as a protein of the granules of human neutrophils, has been recently reported to be implicated in metabolic and inflammatory disorders. This study was designed to evaluate the relationship between serum lipocalin-2 levels, coronary artery disease (CAD) and metabolic syndrome (MS). Method: Serum lipocalin-2 levels of 261 in-patients who underwent coronary angiography were measured by sandwich enzyme immunoassay. Demographic (169 men and 92 postmenopausal women) and clinical (metabolic syndrome (MS), triglyceride (TG) and C-reactive protein (CRP) levels) characteristics were collected to assess independent factors of CAD (CAD: 188 and non-CAD: 73) and serum lipocalin-2 levels by multiple logistic regression and multivariate stepwise regression analyses, respectively.