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Jujić A, Atabaki-Pasdar N, Nilsson PM, Almgren P, Hakaste L, Tuomi T, Berglund LM, Franks PW, Holst JJ, Prasad RB, Torekov SS, Ravassa S, Díez J, Persson M, Melander O, Gomez MF, Groop L, Ahlqvist E, Magnusson M. Glucose-dependent insulinotropic peptide and risk of cardiovascular events and mortality: a prospective study. Diabetologia 2020; 63:1043-1054. [PMID: 31974732 PMCID: PMC7145777 DOI: 10.1007/s00125-020-05093-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 12/18/2019] [Indexed: 12/17/2022]
Abstract
AIMS/HYPOTHESIS Evidence that glucose-dependent insulinotropic peptide (GIP) and/or the GIP receptor (GIPR) are involved in cardiovascular biology is emerging. We hypothesised that GIP has untoward effects on cardiovascular biology, in contrast to glucagon-like peptide 1 (GLP-1), and therefore investigated the effects of GIP and GLP-1 concentrations on cardiovascular disease (CVD) and mortality risk. METHODS GIP concentrations were successfully measured during OGTTs in two independent populations (Malmö Diet Cancer-Cardiovascular Cohort [MDC-CC] and Prevalence, Prediction and Prevention of Diabetes in Botnia [PPP-Botnia]) in a total of 8044 subjects. GLP-1 (n = 3625) was measured in MDC-CC. The incidence of CVD and mortality was assessed via national/regional registers or questionnaires. Further, a two-sample Mendelian randomisation (2SMR) analysis between the GIP pathway and outcomes (coronary artery disease [CAD] and myocardial infarction) was carried out using a GIP-associated genetic variant, rs1800437, as instrumental variable. An additional reverse 2SMR was performed with CAD as exposure variable and GIP as outcome variable, with the instrumental variables constructed from 114 known genetic risk variants for CAD. RESULTS In meta-analyses, higher fasting levels of GIP were associated with risk of higher total mortality (HR[95% CI] = 1.22 [1.11, 1.35]; p = 4.5 × 10-5) and death from CVD (HR[95% CI] 1.30 [1.11, 1.52]; p = 0.001). In accordance, 2SMR analysis revealed that increasing GIP concentrations were associated with CAD and myocardial infarction, and an additional reverse 2SMR revealed no significant effect of CAD on GIP levels, thus confirming a possible effect solely of GIP on CAD. CONCLUSIONS/INTERPRETATION In two prospective, community-based studies, elevated levels of GIP were associated with greater risk of all-cause and cardiovascular mortality within 5-9 years of follow-up, whereas GLP-1 levels were not associated with excess risk. Further studies are warranted to determine the cardiovascular effects of GIP per se.
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Affiliation(s)
- Amra Jujić
- Department of Clinical Sciences Malmö, Lund University, Clinical Research Centre, Hämtställe HS 36, Box 50332, 202 13, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Inga Marie Nilssons gata 49, 20502, Malmö, Sweden
| | | | - Peter M Nilsson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Peter Almgren
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Lund University Diabetes Centre, Lund University, Malmö, Sweden
| | - Liisa Hakaste
- Folkhälsan Research Centre, Biomedicum, Helsinki, Finland
- Research Program Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
- Department of Endocrinology, Helsinki University Hospital, Helsinki, Finland
- Finnish Institute of Molecular Medicine, University of Helsinki, Helsinki, Finland
| | - Tiinamaija Tuomi
- Folkhälsan Research Centre, Biomedicum, Helsinki, Finland
- Research Program Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
- Department of Endocrinology, Helsinki University Hospital, Helsinki, Finland
- Finnish Institute of Molecular Medicine, University of Helsinki, Helsinki, Finland
| | - Lisa M Berglund
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Lund University Diabetes Centre, Lund University, Malmö, Sweden
| | - Paul W Franks
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Public Health & Clinical Medicine, Umeå University, Umeå, Sweden
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | - Jens J Holst
- Department of Biomedical Sciences, The Panum Institute, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Rashmi B Prasad
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Lund University Diabetes Centre, Lund University, Malmö, Sweden
| | - Signe S Torekov
- Department of Biomedical Sciences, The Panum Institute, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Susana Ravassa
- Program of Cardiovascular Diseases, CIMA, University of Navarra, Pamplona, Spain
- CIBERCV, Carlos III Institute of Health, Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra (IdisNA), Pamplona, Spain
| | - Javier Díez
- Program of Cardiovascular Diseases, CIMA, University of Navarra, Pamplona, Spain
- CIBERCV, Carlos III Institute of Health, Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra (IdisNA), Pamplona, Spain
- Department of Cardiology and Cardiac Surgery, University of Navarra Clinic, Pamplona, Spain
- Department of Nephrology, University of Navarra Clinic, Pamplona, Spain
| | | | - Olle Melander
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Maria F Gomez
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Lund University Diabetes Centre, Lund University, Malmö, Sweden
| | - Leif Groop
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Lund University Diabetes Centre, Lund University, Malmö, Sweden
- Department of Endocrinology, Helsinki University Hospital, Helsinki, Finland
| | - Emma Ahlqvist
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Lund University Diabetes Centre, Lund University, Malmö, Sweden
| | - Martin Magnusson
- Department of Clinical Sciences Malmö, Lund University, Clinical Research Centre, Hämtställe HS 36, Box 50332, 202 13, Malmö, Sweden.
- Department of Cardiology, Skåne University Hospital, Inga Marie Nilssons gata 49, 20502, Malmö, Sweden.
- Wallenberg Center for Molecular Medicine, Lund University, Malmö, Sweden.
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