Elevated Pancreatic Polypeptide May Predict Coronary Artery Disease in T2DM

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Age, systolic blood pressure, and number of antihypertensive agents were also independent predictors of CAD.
Age, systolic blood pressure, and number of antihypertensive agents were also independent predictors of CAD.

Fasting pancreatic polypeptide may be a potential marker for macrovascular disease, according to study results presented at ENDO 2017: the 99th Annual Meeting & Expo, April 1-4, in Orlando, Florida.

Researchers from the Imperial College NHS Healthcare Trust in London, United Kingdom and the Imperial College London Diabetes Centre in Abu Dhabi, United Arab Emirates, hypothesized that fasting pancreatic polypeptide would be higher in patients with established coronary artery disease (CAD). 

As they noted, CAD is 2 to 3 times more prevalent in patients with type 2 diabetes, but is often subclinical and undiagnosed.

A total of 1332 adults with normal glucose tolerance (n=231), prediabetes (n=175), or type 2 diabetes (n=926) were examined, and 10-year Framingham risks were estimated using the calculator that incorporates the lipid profile. The primary end point was CAD, defined as "specialist diagnosis in combination with a record of either regional wall motional abnormality or angiographically proven disease."

CAD was present in 8.7% (n=51) of the men and 3.8% (n=28) of the women. Pancreatic polypeptide significantly correlated with Framingham 10-year risk (R2=0.39; P <.0001) after correcting for estimated glomerular filtration rate.

Log-transformed pancreatic polypeptide was an independent predictor of CAD in logistic regression, specifically in men with type 2 diabetes (odds ratio [OR], 5.95; 95% CI, 1.55-22.81; P <.01) when corrected for age, body mass index, diabetes duration, HbA1c, insulin, number of oral hypoglycemic medications, systolic blood pressure, number of antihypertensive medications, high-density lipoprotein-to-triglyceride ratio, statins, smoking status, and estimated glomerular filtration rate.

Log-transformed pancreatic polypeptide remained an independent predictor in logistic regression with the same covariates in men (OR, 4.50; 95% CI, 1.35-15.02; P <.05).

Age, systolic blood pressure, and number of antihypertensive agents were also independent predictors of CAD, as the investigators expected.

Pancreatic polypeptide had a modest predictive value for CAD, but was superior to waist circumference.

"Fasting [pancreatic polypeptide] may provide a more accurate marker of the contribution of central obesity to vascular risk than external measures of body composition," the researchers concluded.

Reference

Sam AH, Buckley A, Meeran K, et al. Fasting pancreatic polypeptide: a novel marker of cardiovascular risk and coronary artery disease in men with type 2 diabetes mellitus. Presented at: ENDO 2017: the 99th Annual Meeting & Expo; April 1-4, 2017; Orlando, FL. Abstract 587.

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