High-sensitivity C-reactive protein level predicted mortality risk in recent-onset type 2 diabetes
While high-sensitivity C-reactive protein was a good predictor of mortality, C-peptide levels were more closely associated with cardiovascular events, and having high levels of both was associated with increased risk of either outcome, a prospective study in Denmark found.
A study found that high-sensitivity C-reactive protein (hs-CRP) is a stronger prognostic biomarker of all-cause mortality than of cardiovascular events in patients with recent-onset type 2 diabetes, while C-peptide better predicts cardiovascular events.
The prospective study measured serum hs-CRP in 7,301 Danish patients with type 2 diabetes, as well as C-peptide levels in 5,765 of the patients. Patients with no history of cardiovascular events at baseline (n=6,407) were followed until first myocardial infarction, stroke, coronary revascularization, or cardiovascular death, and all patients were followed for all-cause mortality. Results were published by Diabetes Care on March 17.
Over a median follow-up of 4.8 years, patients with a high hs-CRP (>3 mg/L) had significantly increased risk of cardiovascular events (adjusted hazard ratio [aHR], 1.45; 95% CI, 1.07 to 1.96) and all-cause mortality (aHR, 2.47; 95% CI, 1.88 to 3.25) compared to those with low hs-CRP (<1 mg/L). The association between cardiovascular events and hs-CRP rose sharply from 0 to 1 mg/L, followed by a plateau from 1 to 3 mg/L and linearly increasing risk above 3 mg/L. Stratification of patients by whether their C-peptide levels were above or below 1,470 pmol/L revealed that high hs-CRP was associated with increased cardiovascular risk in patients with low C-peptide levels (HR, 1.55; 95% CI, 1.06 to 2.29) but not in those with high C-peptide levels (HR, 1.01; 95% CI, 0.57 to 1.79). Those with high levels of both biomarkers had the highest risk of both cardiovascular events (HR, 1.61; 95% CI, 1.10 to 2.34) and all-cause mortality (HR, 2.36; 95% CI, 1.73 to 3.21).
The finding that hs-CRP was a more accurate predictor of mortality risk than of cardiovascular events “may accordingly guide clinicians to improve early detection and prevention of serious diseases other than [cardiovascular disease] in T2D [type 2 diabetes],” the study authors said. “Conversely, elevated C-peptide as a strong CVE [cardiovascular event] biomarker supports the need to target hyperinsulinemia/insulin resistance in T2D CVE prevention.”
Limitations of the study include potential survival and referral biases and that the findings were based on only a single measurement of hs-CRP.