Insulin like growth factor 1 is linked to higher cardiovascular risk score in adults with type 2 diabetes mellitus and chronic kidney disease.

INTRODUCTION: Insulin-like growth factor-1 (IGF-1) is a peptide that shares sequence homology with insulin and has endocrine, paracrine and autocrine functions, acts on endothelial cells, and stimulates angiogenesis. IGF1 also affects renal hemodynamics both directly and indirectly by interacting with the renin-angiotensin system.

OBJECTIVE: The study aimed at detecting a relation between age-adjusted IGF1 (AAIGF1) and cardiovascular risk score in adults with type 2 diabetes mellitus and chronic kidney disease.

DESIGN: Patients were 90 females and 42 males with different stages of CKD ranging from 0 to 4. After taking a consent, serum IGF1 was recorded and adjusted for the age of the patient using the IGF1 score equation: {[(log IGF-1 + 0.00625xage)-2.555]/0.104}. Both univariate and multivariate regression analyses of AAIGF1 to different metabolic parameters and microvascular complications of type 2 DM were done. A ROC curve for CV risk score was issued.

RESULTS: AAIGF1 showed a significant bidirectional change with the stage of CKD. Univariate analysis was done including cardiovascular parameters in relations to AAIGF1. A significant positive correlation was found between AAIGF1 and CV risk score (B = 0.036, p = 0.003), SBP (B = 0.030, P = 0.004) and DBP (B = 0.071, P = 0.000), with a reciprocal relation to EF (B = -0.050, P = 0.016). Multivariate regression showed a significant correlation between AAIGF1 and age, HOMAIR, HOMAB, Uric acid. A ROC curve with AUC of 0.675, P = 0.003, showed that AAIGF1 of approximately -1.7 is a cut off for intermediate CV risk (10 year risk score >7.5%).

CONCLUSION: AAIGF1 shows a bidirectional relation to the grade of chronic kidney disease in adults with type 2 DM. A cut off point for AAIGF1 was set to indicate intermediate CV risk score, which can encourage using AAIGF1 as a prognostic marker for higher CV risk score. Medications that modulate IGF1 level can affect CV risk.