Key result
Elevated baseline HMGB-1 links to higher MACE risk in diabetic patients following lower-extremity revascularization.
Why the study?
PAD is associated with a high risk of adverse events in type 2 diabetes mellitus, and HMGB-1 is associated with diabetic PAD, but its relationship with post-revascularization MACE and MALE required evaluation.
Are baseline serum HMGB-1 levels associated with the incidence of MACE and MALE in diabetic patients with PAD and CLTI undergoing lower-extremity endovascular revascularization?
Cohort (n=201)
No
Are baseline serum HMGB-1 levels associated with the incidence of MACE and MALE in diabetic patients with PAD and CLTI undergoing lower-extremity endovascular revascularization?
Elevated baseline serum HMGB-1 levels are an independent predictor of major adverse cardiovascular and limb events in diabetic patients with chronic limb-threatening ischemia undergoing endovascular revascularization.
Answers are grounded in this paper and cite their sources.
HMGB-1 may aid post-revascularization risk stratification in diabetic CLTI; hypothesis-generating and requires prospective validation before clinical use.
Background: Peripheral arterial disease (PAD) is one of the most disabling cardiovascular complications of type 2 diabetes mellitus and is indeed associated with a high risk of cardiovascular and limb adverse events. High mobility group box-1 (HMGB-1) is a nuclear protein involved in the inflammatory response that acts as a pro-inflammatory cytokine when released into the extracellular space. HMBG-1 is associated with PAD in diabetic patients.The aim of this study was to evaluate the association between serum HMGB-1 levels and major adverse cardiovascular events (MACE) and major adverse limb events (MALE) after lower-extremity endovascular revascularization (LER) in a group of diabetic patients with chronic limb-threatening ischemia (CLTI). Methods: we conducted a prospective observational study of 201 diabetic patients with PAD and CLTI requiring LER. Baseline serum HMGB-1 levels were determined before endovascular procedure. Data on cardiovascular and limb outcomes were collected in a 12-month follow-up. Results: During the follow-up period, 81 cases of MACE and 93 cases of MALE occurred. Patients who subsequently developed MACE and MALE had higher serum HMGB-1 levels. Specifically, 7.5 ng/mL vs 4.9 ng/mL (p < 0.01) for MACE and 7.2 ng/mL vs 4.8 ng/mL (p < 0.01) for MALE. After adjusting for traditional cardiovascular risk factors, the association between serum HMGB-1 levels and cardiovascular outcomes remained significant in multivariate analysis. In our receiver operating characteristic (ROC) curve analysis, serum HMGB-1 levels were a good predictor of MACE incidence (area under the curve [AUC] = 0.78) and MALE incidence (AUC = 0.75). Conclusions: This study demonstrates that serum HMGB-1 levels are associated with the incidence of MACE and MALE after LER in diabetic populations with PAD and CLTI.
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Rando et al. (2022) conducted a cohort in Type 2 diabetes mellitus with peripheral arterial disease and chronic limb-threatening ischemia (n=201). Serum HMGB-1 levels was evaluated on Major adverse cardiovascular events (MACE) (p=<0.01). Elevated baseline serum HMGB-1 levels were significantly associated with the incidence of major adverse cardiovascular events (7.5 ng/mL vs 4.9 ng/mL, p<0.01) in diabetic patients following lower-extremity revascularization.
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