OBJECTIVE To use protein biomarkers to identify people with type 2 diabetes at high risk of cardiovascular outcomes and death. RESEARCH DESIGN AND METHODS Biobanked serum from 4,957 ELIXA (Evaluation of Lixisenatide in Acute Coronary Syndrome) trial participants was analyzed. Forward-selection Cox models identified independent protein risk factors for major adverse cardiovascular events (MACE) and death that were compared with a previously validated biomarker panel. RESULTS NT-proBNP and osteoprotegerin predicted both outcomes. In addition, trefoil factor 3 predicted MACE, and angiopoietin-2 predicted death (C = 0.70 and 0.79, respectively, compared with 0.63 and 0.66 for clinical variables alone). These proteins had all previously been identified and validated. Notably, C statistics for just NT-proBNP plus clinical risk factors were 0.69 and 0.78 for MACE and death, respectively. CONCLUSIONS NT-proBNP and other proteins independently predict cardiovascular outcomes in people with type 2 diabetes following acute coronary syndrome. Adding other biomarkers only marginally increased NT-proBNP’s prognostic value.

中文翻译：

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2 型糖尿病和急性冠脉综合征患者的蛋白质生物标志物和心血管结局：ELIXA 生物标志物研究

目的 使用蛋白质生物标志物来识别心血管结局和死亡风险高的 2 型糖尿病患者。研究设计和方法分析了来自 4,957 名 ELIXA（利西拉来治疗急性冠状动脉综合征）试验参与者的生物样本库血清。前向选择 Cox 模型确定了主要不良心血管事件 (MACE) 和死亡的独立蛋白质风险因素，并与先前验证的生物标志物组进行了比较。结果 NT-proBNP 和骨保护素预测了这两种结果。此外，三叶因子 3 预测 MACE，血管生成素 2 预测死亡（分别为 C = 0.70 和 0.79，而单独的临床变量为 0.63 和 0.66）。这些蛋白质之前都已被鉴定和验证。值得注意的是，仅 NT-proBNP 加上临床危险因素的 C 统计量分别为 0.69 和 0。MACE和死亡分别为78。结论 NT-proBNP 和其他蛋白质可独立预测急性冠状动脉综合征后 2 型糖尿病患者的心血管结局。添加其他生物标志物只会略微增加 NT-proBNP 的预后价值。