Circulating Fibroblast Growth Factor 21 Levels Predict Incident Coronary Heart Disease in Patients with Type 2 Diabetes without Prevalent Cardiovascular Disease

Presentation Number: MON 504
Date of Presentation: April 3rd, 2017

Chi Ho Lee*, Yu Cho Woo, Wing Sun Chow, Chloe YY Cheung, Carol HY Fong, Michele MA Yuen, Aimin Xu, Hung-Fat Tse and Karen SL Lam
University of Hong Kong, Hong Kong, Hong Kong



Fibroblast growth factor 21 (FGF21) has demonstrated beneficial effects on lipid and carbohydrate metabolism. In cross-sectional studies, an association of raised circulating FGF21 levels with coronary heart disease (CHD) was found in some but not all studies. Here we investigated prospectively whether baseline serum FGF21 levels could predict incident CHD in subjects with type 2 diabetes (T2DM) and without known cardiovascular diseases (CVD).


Baseline serum FGF21 levels were measured in 5,746 Chinese subjects with T2DM recruited from the Hong Kong West Diabetes Registry. The role of baseline serum FGF21 levels in predicting incident CHD over a median follow-up of 3.8 years was analyzed using Cox regression analysis. The discrimination of serum FGF21 levels in predicting incident CHD was analyzed using C-statistics, and the incremental value of serum FGF21 levels with reference to a baseline clinical model of conventional cardiovascular risk factors in predicting incident CHD was assessed by the integrated discrimination improvement (IDI) and the category-free net reclassification index (NRI).


Amongst the 3,528 recruited subjects without known CVD, 147 (4.2%) of them developed CHD, with a cumulative incidence of 10.1 per 1,000 person-years. Baseline serum FGF21 levels were significantly higher in those who had incident CHD than those who did not (222.7 pg/ml [92.8 – 438.4] vs. 151.1 pg/ml [75.6 – 274.6]; p <0.001). On multivariable Cox regression analysis, baseline serum FGF21 levels, using an optimal cut-off of 206.22 pg/ml derived from our study, predicted incident CHD (Hazard ratio 1.55; 95% confidence interval [95% CI] 1.10 – 2.18; p = 0.012), and significantly improved NRI and IDI, after adjustment for conventional cardiovascular risk factors.


Baseline circulating FGF21 levels predicted incident CHD. Further studies are warranted to validate its usefulness as a marker for identifying T2DM subjects with raised CHD risk for primary prevention.


Nothing to Disclose: CHL, YCW, WSC, CYC, CHF, MMY, AX, HFT, KSL