Why the study?
The best strategy to establish cardiovascular risk in women remains undefined, and adding endothelial biomarkers such as VCAM-1 to risk scores could improve risk assessment.
VCAM-1 levels are associated with high cardiovascular risk as predicted by the Framingham Risk Score in diabetic women without prior cardiovascular disease, suggesting its potential utility in detecting subclinical endothelial dysfunction.
VCAM-1 association with elevated CVR in T2DM women is hypothesis-generating; leaves open whether biomarker addition improves risk scores.
Background The best strategy to establish cardiovascular risk (CVR) in women has yet to be defined, although risk scores are widely used. The inclusion of endothelial biomarkers, such as vascular cell adhesion molecule-1 (VCAM-1), to the risk scores could increase their discriminatory power and improve risk assessment. Objective To evaluate the association between endothelial biomarkers and CVR in women with type 2 DM (T2DM) and without previous cardiovascular disease (CVD). Methods Cross-sectional study, including women with T2DM from Fortaleza, Brazil, from January to October 2017. Women aged 30 to 74 years were included and those with CVD were excluded. Clinical and laboratory data were evaluated (age; time of T2DM diagnosis; hypertension presence and treatment; smoking; body mass index - BMI; systolic blood pressure - SBP and diastolic blood pressure - DBP; glycemic and lipid profiles and serum biomarkers VCAM-1, fibroblast growth factor-23, Syndecan-1 and Angiopoietin-2). The CVR was stratified using the Framingham Risk Score - FRS (version with laboratory tests - laboratory FRS and the one with the BMI - non-laboratory FRS) and the United Kingdom Prospective Diabetes Study (UKPDS) risk engine. Results In total, eighty-eight diabetic women were evaluated, with mean age 56 ± 10 years and T2DM time of 5 (3–9) years, most of them hypertensive (71.6%), overweight or obese (74%), with altered blood glucose levels (blood glucose 8.53 ± 3.65 mmol/L and hbA1c of 65 ± 1 mmol/mol) and lipids (LDL 27.06 ± 8.99 mmol/L), in addition to high risk according to laboratory (72.7%) and non-laboratory (81.8%) FRS and low risk for any UKPDS score outcome. Regarding the biomarkers, only VCAM-1 showed an association with CVR, mainly with a high-risk classification using laboratory FRS (p = 0.024), even in this population without CVD. Conclusion The assessed diabetic women without previous CVD had high CVR in traditional scores (FRS scores) and low CVR in specific score for diabetics (UKPDS score). VCAM-1 may be useful in detect subclinical endothelial dysfunction in women with T2DM and its incorporation into scores may improve the accuracy in risk stratification of women with T2DM.
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Néri et al. (2021) studied this question.
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