CRP and fibrinogen imply clinical outcome of patients with Type-2 diabetes and coronary artery disease

operating characteristics; SEM, standard error of the mean; TNF, tumor necrosis factor Patients with type-2 diabetes have accelerated atherosclerosis and vascular disease, which is a result of endothelial injury leading to accumulation of platelets at the site of injury [1].Further, abnormalities in smooth muscle cell proliferation, elevated low density lipoprotein (LDL), and changes in coagulation all contribute to accelerated atherosclerosis in type-2 diabetic patients.Other risk factors such as, hyperglycemia, glucose intolerance, obesity and hypertension are well established risk factors for diabetic vascular disease [2].Physical inactivity and sedentary lifestyles should not be discounted [3, 4].Furthermore, in the INVADE study (Intervention Project on Cerebrovascular Diseases and Dementia in the Community of Ebersberg, Bavaria), it was noted that the combination of hyperglycemia measured as hemaglobin A1c levels (HbA1c) and overall inflammatory state as measured by C-reactive protein (CRP), is associated with progression of atherosclerosis and increased risk of vascular disease in type-2 diabetic patients [2].Interestingly, the combination of HbA1c and CRP in non-diabetic subjects also demonstrated increased atherosclerosis progression [2].Despite this information, it is still not clear why some type-2 diabetic patients with the same duration of diabetic disease and the same metabolic control, have different clinical outcome.Chronic inflammation involving pro-inflammatory cytokines (primarily tumor necrosis factor (TNF)-alpha and interleukin (IL)-6) are highly prevalent in chronic conditions