Levels Of Plasma Prekallikrein Predict Myocardial Infarction In Non-Hispanic White Participants Of The Veterans Affairs Diabetes Trial (Vadt)

We hypothesize in diabetes that augmented activity of the plasma kallikrein-kinin system reflect and contribute to vascular damage and inflammations. Our objective was to determine the role of plasma PK as a predictor of cardiovascular events in type 2 diabetes in the VADT cohort. Levels of plasma total prekallikrein (PK) were measured in 604 VADT patients, a median of 1.5 years after entry into the study. Participants were followed an average of 4.1 years. Hazard ratios (HRs) for CV endpoints in relation to PK tertiles and having a non-zero versus zero value for plasma active kallikrein (PAK) were calculated by Cox proportional hazard models. During follow-up, 4.9% had an MI and 7.4% had an MI or cardiovascular death. Because there was evidence that minority status modified the associations between PK and outcomes of interest, but there was very limited power in minorities, results are presented in the total population adjusting for minority status and limited to the non-Hispanic white (NHW) population (Table). After adjustments by conventional risk factors, in NHW individuals the hazard ratio comparing the middle to lowest tertile of PK levels was 3.94 (95% CI: 1.09, 14.2) for MI and 3.45 (95% CI: 1.25, 9.48) for MI combined with cardiovascular death. Our study indicates that plasma PK levels predict MI and cardiovascular death in NHW patients with type 2 diabetes. Disclosure K.J. Hunt: None. M.A. Jaffa: None. M. Sohn: None. M.F. Lopes-Virella: None. A.A. Jaffa: None. Funding National Heart, Lung, and Blood Institute