DOI: http://dx.doi.org/10.18203/2349-3933.ijam20191472

Study of highly sensitive C-reactive protein in type 2 diabetes mellitus and prediction of cardiovascular risk with glycemic status

T. Doraickannu, T. Sechassayana, S. Vithiavathi, Momin Varisali

Abstract


Inflammation plays a vital role in accentuating the formation of atherosclerotic plaque in diabetes mellitus. So, the measurements of inflammatory markers provide a method of assessing cardiovascular risk. Among the inflammatory markers, highly sensitive C-reactive protein (hs-CRP) is used to detect the low-level inflammation when it is within the normal range. Also, hs-CRP measurement may be useful for assessment of the risk of complication in diabetes patients. So, the present study is conducted to measure plasma hs-CRP level in T2DM and to determine adequate glycaemic control reduces hs-CRP level. The objectives of this study were to correlate HbA1c and hs-CRP in T2DM and predict cardiovascular risk with glycaemic status.

Methods: Authors took 50 diabetic patients. The investigation includes FBS, PPBS, hs-CRP and HbA1c. hs-CRP is measured by immunoturbidimetry method. The reports were collected and compared with normal reference range.

Results: The correlation between hs-CRP levels and HbA1c level after six months show a significant relationship where mean HbA1c values on day 1 and after 6 months were 8.088±1.219 and 7.518±0.693 respectively. The hs-CRP values were 2.508±1.050 on day 1 and 2.15±0.927 after 6 months proving that better glycaemic controls decrease hs-CRP thereby decreasing cardiovascular risk.

Conclusions: hs-CRP values are directly related to HbA1c and better glycaemic control reduces risk of CVD.


Keywords


CVD, Type 2 DM, HbA1c, hs-CRP

Full Text:

PDF

References


Power AC. Diabetes mellitus: Diagnosis, classification and pathophysiology. In: Chapter 417 in Harrisons principles of internal medicine; Kasper DL, Fauci AS, Hauser SL, Lomgo DL, Jameson JL, Loscalzo J, eds. USA; McGrew- Hill: 19th ed; 2015;2:2399.

Centers for disease control and prevention. National diabetes statistics report: Estimates of diabetes and its burden in the United States, 2014. Atlanta, GA: US Department of Health and Human Services; 2014.

Rivellese AA, Riccardi G, Vaccaro O. Cardiovascular risk in women with diabetes. Nutrit Metabol Cardiovasc Dis. 2010;20(6):474-80.

Duncan B, Schmidt M, Pankow J, Ballantyne C. Atherosclerosis risk in communities study. Low-grade systemic inflammation and the development of type 2 diabetes: the atherosclerosis risk in communities study. Diab. 2003;52:1799-05.

Libby P. Mechanisms of acute coronary syndromes and their 11. implications for therapy. N Engl J Med. 2013;368:2004-13.

Black S, Kushner I, Samols D. C-reactive protein. J Biol Chem. 2004;279:48487-90.

Roberts WL, CDC/AHA. CDC/AHA workshop on markers of inflammation and cardiovascular disease: application to clinical and public health practice: laboratory tests available to assess inflammation-performance and standardization: a background paper. Circul. 2004;110:e572-6.

Ridker PM, Buring JE, Rifai N, Cook NR. Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds risk score. JAMA. 2007;297(6):611-9.

Ridker PM, Morrow DA, Rose LM, Rifai N, Cannon CP, Braunwald E. Relative efficacy of atorvastatin 80mg and pravastatin 40 mg in achieving the dual goals of low-density lipoprotein cholesterol <70mg/dl and C-reactive protein <2mg/l: an analysis of the prove-it timi-22 trial. J Am Coll Cardio. 2005;45(10):1644-8.

Ridker PM, Rifai N, Pfeffer MA, Sacks F, Braunwald E. Long-term effects of pravastatin on plasma concentration of C-reactive protein. Circul. 1999;100(3):230-5.

Albert MA, Danielson E, Rifai N, Ridker PM, Prince investigators. Effect of statin therapy on C-reactive protein levels: the pravastatin inflammation/CRP evaluation (Prince): a randomized trial and cohort study. JAMA. 2001;286(1):64-70.

Ridker PM, Danielson E, Fonseca FA, Genest J, Gotto Jr AM, Kastelein JJ, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. New Eng J Med. 2008;359(21):2195.

American diabetes association. Erratum. classification and diagnosis of diabetes. Sec. 2. In standards of medical care in diabetes-2016. Diabetes Care. 2016;39(1):S13-22.

Yousuf O, Bibhu D, Martin S, Joshi H, Blaha J. High-sensitivity C-reactive protein and cardiovascular disease: J Am Coll Cardiol. 2013;62(5):397-08.

American Diabetes association. Consensus statement: role of cardiovascular risk factors in prevention and treatment of macrovascular disease in diabetes. Diab Care. 1993;16:72-8.

Brownlee M, Cerami A, Vlassara H. Advanced glycosylation endproducts in tissue and the biochemical basis of diabetic complications. N Engl J Med. 1988;318:1315-21.

Ikeda K, Higashi T, Sano H, Jinnouchi Y, Yoshida M, Araki T, et al. N ε-(carboxymethyl) lysine protein adduct is a major immunological epitope in proteins modified with advanced glycation end products of the Maillard reaction. Biochem. 1996;35(24):8075-83.

Reddy S, Bichler J, Wells-Knecht KJ, Thorpe SR, Baynes JW. N. epsilon-(carboxymethyl) lysine is a dominant advanced glycation end product (AGE) antigen in tissue proteins. Biochem. 1995;34(34):10872-8.

Pfutzner A, Forst T. High sensitivity C-reactive protein as cardiovascular risk marker in patients with diabetes mellitus. Diab Technol Ther. 2006;8(1):28-36.

Liu S, Manson J, Buring J, Stampfer M. Relation between a diet with a high glycemic load and plasma concentrations of high-sensitivity C-reactive protein in middle-aged women. Am J Clin Nutr. 2002;75:492-8.

Asegaonkar S, Marathe A, Tekade M, Cherekar L. High-sensitivity C-reactive protein: a novel cardiovascular risk predictor in type 2 diabetics with normal lipid profile. J Diab Complic. 2011;25:368-70.

Deepak Y, Denis X, Alben S. High sensitivity C-reactive protein and cardiovascular disease: An Indian perspective. Indian J Med Res. 2015;142:261-8.

David C, Paul M. Clinical significance of hs-CRP in cardio vascular disease. Biomarkers in Medicine. Circulation. 2007;2:229-41.

Mishra DP, Das S, Sahu P. Prevalence of inflammatory markers (high-sensitivity C-reactive protein, nuclear factor-κB, and adiponectin) in Indian patients with type 2 diabetes mellitus with and without macrovascular complications. Meta Syndr Relat Dis. 2012;10:209-13.