Urinary liver-type fatty acid binding protein is an independent predictor of stroke and mortality in individuals with type 1 diabetes

Nicolae M. Panduru, Carol Forsblom, Markku Saraheimo, Lena M. Thorn, Daniel Gordin, Nina Elonen, Valma Harjutsalo, Angelika Bierhaus, Per M. Humpert, Per-Henrik Groop, FinnDiane Study Grp

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Aims/hypothesis: In type 1 diabetes, cardiovascular disease (CVD) and diabetic nephropathy progress in parallel, thereby potentiating the risk of premature death during their development. Since urinary liver-type fatty acid binding protein (L-FABP) predicts the progression of diabetic nephropathy, the aim of this study was to investigate whether urinary L-FABP also predicts cardiovascular outcomes and mortality.

Methods: We tested our hypothesis in a Finnish cohort of 2329 individuals with type 1 diabetes and a median follow-up of 14.1 years. The L-FABP to creatinine ratio was determined from baseline urine samples. The predictive value of urinary L-FABP was evaluated using Cox regression models, while its added predictive benefit for cardiovascular outcomes and mortality was evaluated using a panel of statistical indexes.

Results: Urinary L-FABP predicted incident stroke independently of traditional risk factors (HR 1.33 [95% CI 1.20, 1.49]) and after further adjustment for eGFR (HR 1.28 [95% CI 1.14, 1.44]) or AER (HR 1.24 [95% CI 1.06, 1.44]). In addition, it predicted mortality independently of traditional risk factors (HR 1.34 [95% CI 1.24, 1.45]), and after adjustment for eGFR (HR 1.29 [95% CI 1.18, 1.39]) or AER (HR 1.22 [95% CI 1.09, 1.36]). Urinary L-FABP was as good a predictor as eGFR or AER, and improved the AUC for both outcomes on top of traditional risk factors, with no reclassification benefit (integrated discrimination improvement/net reclassification improvement) for stroke or mortality when AER or eGFR were added to traditional risk factors. However, urinary L-FABP was not a predictor of other cardiovascular endpoints (coronary artery disease, peripheral vascular disease and overall CVD events) when adjusted for the AER.

Conclusions/interpretation: Urinary L-FABP is an independent predictor of stroke and mortality in individuals with type 1 diabetes.
Original languageEnglish
JournalDiabetologia
Volume60
Issue number9
Pages (from-to)1782-1790
Number of pages9
ISSN0012-186X
DOIs
Publication statusPublished - Sep 2017
MoE publication typeA1 Journal article-refereed

Fields of Science

  • Cardiovascular disease
  • Diabetic complications
  • Liver-type fatty acid binding protein
  • Mortality
  • Stroke
  • Type 1 diabetes
  • Urinary biomarkers
  • Urinary L-FABP
  • ALL-CAUSE MORTALITY
  • METABOLIC SYNDROME
  • CARDIOVASCULAR-DISEASE
  • CLINICAL-SIGNIFICANCE
  • HEART-DISEASE
  • RENAL-DISEASE
  • RISK-FACTORS
  • BRAIN-TYPE
  • NEPHROPATHY
  • PROGRESSION
  • 3121 General medicine, internal medicine and other clinical medicine

Cite this