Abstract 18133: Variations of Circulating Levels of Insulin-Like Growth Factor 1 Impact Two-Years Clinical Outcome Following Acute Myocardial Infarction.
Background: Levels of insulin-like growth factor-1 (IGF-1) have been related to future type 2 diabetes and atherosclerosis. Few small studies have examined the impact of IGF-1 serum levels on cardiovascular outcomes after an acute myocardial infarction (MI) in patients with or without diabetes.
Aim: We examined whether insulin-like growth factor-1 (IGF-1) at admission for AMI predicted death, recurrent MI, and stroke during 2 years follow-up. METHODS : The FAST-MI registry included consecutive pts with ST-elevation or non-ST elevation MI <48 hours of symptom onset, in 223 French intensive care units (60% of all French ICUs) over 1 month. In all, 3059 pts were recruited, of whom 1005 patients participated in the serum databank. Two years follow-up was 99% complete. As IGF1 decreases with age, a standardized IGF1 score was calculated as previously described (IGF = (Log [IGF-1] + 0.00625 × age - 2.555) / 0.104). Tertiles of the standardized IGF-1 score were also compared with regard to the outcomes. Multiple Cox proportional hazard regression was used to study the relationship between IGF-1 levels with the clinical outcomes and the variables.
Results: During the two-years follow-up, 190 patients (19%) died or had a recurrent AMI or stroke. Higher IGF-1 score was an independent predictor of events after adjustment for sex, kilipp score, known cardiovascular risk factors including diabetes, CRP, and treatments including statins and beta-blockers (p< 0.004). Similarly, lower tertiles of IGF1 score remained significantly associated with the risk of outcomes events after adjustment : : 1.79 (1.16-2.74) and 1.55 (0.97-2.47) for first and second tertiles compared to thrid tertile (p trend < 0.03). In both diabetic and non diabetic patients, lower tertiles of IGF-1 was associated with outcomes. However, the impact of this relationship was strongest among diabetic patients: 2.31 (1.33-4.03) and 1.30 (0.69-2.45) for first and second tertiles compared to thrid tertile (p trend < 0.003).
Conclusions: Low serum IGF-1 levels are associated with increased risk of all cause-death, recurrent MI and stroke in patients with AMI with or without diabetes.
- © 2010 by American Heart Association, Inc.