Key result
In high-risk patients with type 2 diabetes, a one-unit increase in log(hs-CRP) was associated with a 26% increased risk of all-cause mortality (HR 1.26) and a 21% increased risk of vascular mortality, but not with cardiovascular events.
Why the study?
High sensitive-CRP is associated with cardiovascular events in various populations, but its relation to incident cardiovascular events and all-cause mortality in high-risk type 2 diabetes patients required evaluation.
Does elevated hs-CRP increase the risk of cardiovascular events and all-cause mortality in high-risk patients with type 2 diabetes?
Cohort (n=1,679)
No
Does elevated hs-CRP increase the risk of cardiovascular events and all-cause mortality in high-risk patients with type 2 diabetes?
Hazard Ratio: 1.26 (95% CI 1.1–1.45)
p-value: p=<0.05
In high-risk patients with type 2 diabetes, low-grade inflammation (measured by hs-CRP) is an independent risk factor for vascular and all-cause mortality, but not for non-fatal cardiovascular events.
hs-CRP may stratify mortality risk in high-risk T2D; leaves open whether inflammation is causal or modifiable.
BACKGROUND: Type 2 diabetes is a condition associated with a state of low-grade inflammation caused by adipose tissue dysfunction and insulin resistance. High sensitive-CRP (hs-CRP) is a marker for systemic low-grade inflammation and higher plasma levels have been associated with cardiovascular events in various populations. The aim of the current study is to evaluate the relation between hs-CRP and incident cardiovascular events and all-cause mortality in high-risk type 2 diabetes patients. METHODS: Prospective cohort study of 1679 type 2 diabetes patients included in the Second Manifestations of ARTerial disease (SMART). Cox proportional hazard models were used to evaluate the risk of hs-CRP on cardiovascular events (composite of myocardial infarction, stroke and vascular mortality) and all-cause mortality. Hs-CRP was log-transformed for continuous analyses. Findings were adjusted for age, sex, BMI, current smoking and alcohol use, non-HDL-cholesterol and micro-albuminuria. RESULTS: 307 new cardiovascular events and 343 deaths occurred during a median follow-up of 7.8 years (IQR 4.2-11.1). A one unit increase in log(hs-CRP) was related to an increased vascular- and all-cause mortality risk (HR 1.21, 95% CI 1.01-1.46 and HR 1.26, 95% CI 1.10-1.45 respectively). No relation was found between log(hs-CRP) and myocardial infarction or stroke. The relations were similar in patients with and without previous vascular disease. CONCLUSION: Low grade inflammation, as measured by hs-CRP, is an independent risk factor for vascular- and all-cause mortality but not for cardiovascular events in high-risk type 2 diabetes patients. Chronic low-grade inflammation may be a treatment target to lower residual cardiovascular risk in type 2 diabetes patients.
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Sharif et al. (2021) conducted a cohort in Type 2 diabetes (n=1,679). High-sensitivity C-reactive protein (hs-CRP) vs. Lower hs-CRP levels was evaluated on All-cause mortality (per 1 unit increase in log(hs-CRP)) (HR 1.26, 95% CI 1.10-1.45, p=<0.05). In high-risk patients with type 2 diabetes, a one-unit increase in log(hs-CRP) was associated with a 26% increased risk of all-cause mortality (HR 1.26) and a 21% increased risk of vascular mortality, but not with cardiovascular events.
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