Association of C-reactive protein with coronary heart disease risk factors in patients with type 2 diabetes mellitus

Association Between Systemic Immune Inflammation Level and Poor Prognosis Across Different Glucose Metabolism Status in Coronary Artery Disease Patients

Background

Blood glucose levels significantly affect the clinical prognosis of patients with coronary artery disease (CAD), and systemic immune inflammation is a common risk factor for both CAD and diabetes. However, the relationship between immune inflammation levels and poor prognosis in patients with CAD with different glucose metabolic statuses remains unclear.

Methods

Between January 2007 and December 2020, we recruited 84,645 patients with CAD. The systemic immune inflammation index (SII) was used to comprehensively reflect the immune and inflammatory levels of patients and was calculated using the following formula: neutrophils × platelets/lymphocytes. The patients were classified into nine groups according to their glucose metabolism status (diabetes mellitus [DM], pre-diabetes mellitus [pre-DM], and normal glucose regulation [NGR]). Cox regression models and competing risk Fine and Gray models were used to investigate the association between SII and clinical outcomes.

Results

During the follow-up period, 12,578 patients died, including 5857 cardiovascular-related and 1251 cancer-related deaths. The risk of all-cause and cause-specific mortality increased with increasing SII tertiles in CAD patients with NGR, pre-DM, and DM. When considering glucose metabolism status, the multivariate cox regression revealed that CAD patients with DM and SII-H levels had the highest risk of all-cause mortality (1.69 [1.56-1.83]), cardiovascular mortality (2.29 [2.02-2.59]), and cancer mortality (1.29 [1.01-1.66]). Moreover, incorporating the SII into traditional risk factor models significantly improved the C-index for predicting all-cause and cardiovascular mortality.

Conclusion

Systemic immune inflammation levels on admission were correlated with a higher risk of all-cause and cause-specific mortality in patients with CAD, particularly in those with DM.

Salsalate Improves Postprandial Glycemic and Some Lipid Responses in Persons With Tetraplegia: A Randomized Clinical Pilot Trial With Crossover Design

Objectives

To investigate the effects of salsalate on fasting and postprandial (PP) glycemic, lipidemic, and inflammatory responses in persons with tetraplegia.

Methods

This study was a randomized, double-blind, cross-over design. It was conducted at a university laboratory. Ten males aged 25 to 50 years with SCI at C5-8 levels for ≥1 year underwent 1 month of placebo and salsalate (4 g/day) treatment. Blood samples were drawn before and 4 hours after breakfast and lunch fast-food meal consumption.

Results

Descriptive statistics indicate that fasting and PP glucose values were reduced with salsalate (pre-post mean difference, 4 ± 5 mg/dL and 8 ± 8 mg/dL, respectively) but largely unchanged with placebo (0 ± 6 mg/dL and -0 ± 7 mg/dL, respectively). Insulin responses were generally reciprocal to glucose, however less pronounced. Fasting free fatty acids were significantly reduced with salsalate (191 ± 216 mg/dL, p = .021) but not placebo (-46 ± 116 mg/dL, p = .878). Results for triglycerides were similar (25 ± 34 mg/dL, p =.045, and 7 ± 29 mg/dL, p = .464). Fasting low-density lipoprotein (LDL) levels were higher after salsalate (-10 ± 12 mg/dL, p = .025) but not placebo (2 ± 9 mg/dL, p = .403) treatment. Inflammatory markers were largely unchanged.

Conclusion

In this pilot trial, descriptive values indicate that salsalate decreased fasting and PP glucose response to fast-food meal challenge at regular intervals in persons with tetraplegia. Positive effects were also seen for some lipid but not for inflammatory response markers. Given the relatively "healthy" metabolic profiles of the participants, it is possible that salsalate's effects may be greater and more consistent in people with less favorable metabolic milieus.

Comparative Study of New Biomarkers in Iraqi DM2 with and without Complications

Background

Recent research indicates that persistent inflammatory responses may contribute to the rise of diabetic nephropathy (DN) and diabetic cardiovascular disease (DCVD) in type 2 diabetes mellitus patients (DM2). Numerous molecules associated with inflammation and angiogenesis have been implicated in the development and progression of DN and DCVD, respectively.

Methods

The subjects were separated into five groups: healthy controls (n= 25), type 2 diabetes mellitus patients (n= 30), type 2 diabetes mellitus patients with nephropathy DN (n= 30), and type 2 diabetes mellitus patients with cardiovascular disease DCVD (n= 30). The blood levels of irisin, IL-8, HbA1C, urea, and creatinine were determined.

Results

In current study there was high significant increased irisin levels (p< 0.001) in DN patients than other groups and a high significant decreased IL-8 level in DCVD.

Discussion

Serum IL-8 and irisin levels may serve as early indicators of DM2 problems (DN, DCVD).

Cardiovascular Disease in Type 2 Diabetes: A Review of Sex-Related Differences in Predisposition and Prevention

Type 2 diabetes mellitus is a major risk factor for cardiovascular disease. However, compiled data suggest that type 2 diabetes affects the risk of cardiovascular disease differentially according to sex. In recent years, large meta-analyses have confirmed that women with type 2 diabetes have a higher relative risk of incident coronary heart disease, fatal coronary heart disease, and stroke compared with their male counterparts. The reasons for these disparities are not completely elucidated. A greater burden of cardiometabolic risk in women was proposed as a partial explanation. Indeed, several studies suggest that women experience a larger deterioration in major cardiovascular risk factors and put on more weight than do men during their transition from normoglycemia to overt type 2 diabetes. This excess weight is associated with higher levels of biomarkers of endothelial dysfunction, inflammation, and procoagulant state. Moreover, sex differences in the prescription and use of some cardiovascular drugs may compound an "existing" disparity. We searched PubMed for articles published in English and French, by using the following terms: ("cardiovascular diseases") AND ("diabetes mellitus") AND ("sex disparity" OR "sex differences" OR "sex related differences" OR "sex-related differences" OR "sex disparities"). In this article, we review the available literature on the sex aspects of primary and secondary prevention of cardiovascular disease in people with type 2 diabetes, in the predisposition to cardiovascular disease in those people, and in the control of diabetes and associated cardiovascular risk factors.

Clinical significance of serum interleukin-8 and soluble tumor necrosis factor-like weak inducer of apoptosis levels in patients with diabetic nephropathy

AIMS/INTRODUCTION

Recent studies suggest that chronic inflammatory responses are important in the development of diabetic nephropathy (DN). Various inflammatory and angiogenesis molecules affect the pathogenesis and progression of DN. Inflammation damages the microcirculation and causes kidney damage. In the present study, we studied changes in interleukin-8 (IL-8) and soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) levels in patients with DN, and investigated the clinical significance of these two inflammatory factors.

MATERIALS AND METHODS

Participants were categorized into healthy controls (n = 30) and patients with type 2 diabetes mellitus (n = 124). The type 2 diabetes mellitus group was further subdivided into the normoalbuminuria (n = 34), microalbuminuria (MAU; n = 46,) and proteinuria (MaAU; n = 44,) groups. Patients with DN were included in the MAU and MaAU groups. Total cholesterol, triglyceride, low-density lipoprotein cholesterol, glycosylated hemoglobin, fasting blood glucose, 2-h postprandial blood glucose, blood urea nitrogen, serum creatinine, 24-h urine microalbumin, IL-8 and sTWEAK levels were measured. Logistic regression was used to analyze the factors associated with proteinuria.

RESULTS

In the healthy controls, normoalbuminuria, MAU and MaAU groups, we found that IL-8 levels increased, whereas sTWEAK levels decreased (P < 0.05). IL-8 might be an independent risk factor and serum sTWEAK a protective factor for MAU and MaAU. Serum levels of sTWEAK, IL-8 and microalbumin were significantly correlated in the MAU and MaAU groups.

CONCLUSIONS

Serum IL-8 and sTWEAK levels might be markers that can be used for an early diagnosis of DN.

Telmisartan decreases microalbuminuria in patients with type 2 diabetes mellitus following coronary artery bypass grafting

Objective:

This prospective study aimed to investigate the effects of the selective angiotensin receptor antagonist, telmisartan, on microalbuminuria after coronary artery bypass surgery in patients with diabetes mellitus.

Methods:

Patients were divided into two groups with block randomisation, using the sealed envelope technique: group T (telmisartan group) consisted of patients who received the angiotensin receptor blocking agent telmisartan 80 mg daily for at least six months in the pre-operative period; group N-T (non-telmisartan group) consisted of patients who received no telmisartan treatment. Clinical and demographic characteristics, operative and postoperative features, microalbuminuria and high-sensitivity C-reactive protein levels were compared.

Results:

Forty patients met the eligibility criteria for the study. The groups did not differ with regard to clinical and demographic characteristics, and operative and postoperative features. Microalbuminuria levels between the groups differed significantly in the pre-operative period, first hour postoperatively and fifth day postoperatively. C-reactive protein levels between the groups differed significantly on the fifth day postoperatively.

Conclusion:

Telmisartan was useful for decreasing systemic inflammation and levels of urinary albumin excretion in patients who had type 2 diabetes mellitus and had undergone coronary artery bypass surgery.

Increased concentration of C-reactive protein in obese patients with type 2 diabetes is associated with obesity and presence of diabetes but not with macrovascular and microvascular complications or glycemic control

The purpose of this study was to assess the concentration of C-reactive protein (CRP) in obese type 2 diabetes mellitus (DM2) patients and its association with macrovascular and microvascular complications. The study group consisted of 80 obese DM2 patients, including 20 macrovascular, 20 microvascular, 20 both macrovascular and microvascular, and 20 with no complications patients. The control group comprised 40 normoglycemic subjects—20 obese and 20 of normal body weight. Highly sensitive CRP and metabolic control parameters were assessed. CRP levels in obese diabetes subgroups and normoglycemic obese were similar and significantly higher than those in nonobese controls. No correlation was found between CRP and diabetes control parameters. There was a strong positive correlation between CRP level and body mass index in all groups. A multivariate analysis showed that DM2 and obesity are independent factors increasing CRP levels. Increased concentration of CRP in obese DM2 patients is related to obesity and diabetes itself. The lack of association between CRP and vascular complications remains unclear.

Attenuated NOx responses and myocardial ischemia, a possible risk for structural vascular disease in African men: the SABPA study

Chronically elevated blood pressure has been associated with impaired NO-mediated vasodilation and structural vascular disease risk. This study aimed to determine whether significant associations exist regarding NO metabolite (NOx) responses, cardiovascular function and structural vascular disease in a cohort of African and Caucasian men. The study included 81 African and 94 Caucasian male teachers stratified via median splits into low and high NOx ethnic groups. Ambulatory blood pressure, electrocardiogram monitoring and ultrasound carotid intima-media thickness (CIMT) images were obtained. Cardiovascular measurements and fasting blood for NOx responses were measured during rest and on challenging the cardiovascular system with the Stroop colour-word conflict test. African men displayed significantly higher resting NOx as well as higher number of 24 h silent ischemic events than their Caucasian counterparts. Low NOx African men displayed enhanced α-adrenergic and ECG ST segment depression acute mental stress responses as well as 24 h silent ischemic events associated with CIMT (adjusted R(2) = 0.47; β = 0.25; confidence interval (CI) = 0.13, 0.41). African men demonstrated a vulnerable cardiovascular profile. Novel findings revealed α-adrenergic-driven blood pressure responses and less NO bioavailability during acute stress. The association between myocardial ischemia and CIMT in this group emphasized their risk for future coronary artery disease and cerebrovascular events.

Determining the Relationship Between Homocysteinemia and Biomarkers of Inflammation, Oxidative Stress and Functional Kidney Status in Patients with Diabetic Nephropathy

Background: One of the leading causes of terminal renal failure is diabetic nephropathy. The aim of this study was to determine the relationship between homocysteine levels and the biomarkers of renal function, inflammation and oxidative stress, as well as the incidence of macrovascular complications in patients with diabetic nephropathy.

Methods: Sixty-four patients with diabetic nephropathy were included in this study. They were divided according to their homocysteine levels into two groups: hyperhomocysteinemic (HHcy, n=47) and normohomocysteinemic patients (NHCy, n=17). The re sults were compared to a control group (n=20) with normal renal function and without diabetes. Besides homocysteine, cystatine C, creatinine, urea, albuminuria, creatinine clearance, lipid status parameters, apolipoprotein A-I and B, lipo protein (a), CRP, fibrinogen, oxidative LDL were determined using appropriate methods. The incidence of macro vascular diabetic complications was also determined.

Results: The results indicate that the level of renal dysfunction is greater in HHcy than in NHcy patients (p<0.05). In HHcy patients levels of oxLDL were also higher compared to NHcy patients (119.3±140.4 vs. 71.4±50.8 ng/mL, disp< 0.05) as well as fibrinogen levels (4.3±1.3 vs. 3.7±0.8 g/L, p<0.05). The in cidence of macrovascular complications is more frequent in HHcy than in NHcy patients (55.3. vs. 35.3 %, p>0.05), and in patients with macroalbuminuria compared to patients with microalbuminuria (65% vs. 39%, p<0.05).

Conclusions: It can be concluded that HHcy is significantly present in patients with diabetic nephropathy, especially if there is greater reduction of renal function. Besides that, significantly higher concentrations of inflammatory (fibrinogen) and oxidative stress (oxLDL) markers were present in HHcy patients with diabetic nephropathy compared to NHcy patients.Therefore in diabetic nephropathy patients it is useful to regularly monitor the levels of homocysteine, as well as inflammatory and markers of oxidative stress.

Association between microalbuminuria and cardiovascular disease in type 2 diabetes mellitus of the Beijing Han nationality

The objective of this study is to investigate the correlation of urinary albumin excretion rate (UAER) with the incidence of coronary heart disease (CHD), pathological characteristics and severity of coronary atherosclerosis in patients with type 2 diabetes mellitus (T2DM), and explore the efficacy of using the urinary albumin excretion rate (UAER) to predict the risk of CHD in patients with T2DM. The study included 1,004 T2DM patients with normo- and micro-albuminuria who underwent coronary angiography for suspected coronary atherosclerosis. The severity of coronary atherosclerosis was defined using the Gensini's score system. The correlation of UAER with the incidence of CHD, pathological characteristic and the severity of coronary atherosclerosis in patients with T2DM was analyzed. The best numerical value of UAER in predicting the risk of CHD in patients with T2DM was calculated. The differences in sex, age, BMI, SBP, history of smoking, duration of diabetes mellitus, HbA1C, FPG, LDL-C, HDL-C, Cre, Uric acid, HOMA-IR between microalbuminuria(MAU) subgroup and normal albuminuria subgroup were statistically significant(P < 0.05). The differences in the incidence of CHD, the number of pathological coronary vessels, the Gensini's score and LVEF% between microalbuminuria group and normal albuminuria group were statistically significant (P < 0.05). UAER increased significantly with an increase in the number of pathological coronary vessels. Logistic multiple regression analysis showed that UAER was independently correlated with the incidence of CHD (OR = 1.092, P = 0.000, 95% CI = 1.063-1.122). Spearman's correlation analysis showed that the Gensini's score was significantly positively correlated with UAER, sex, age, BMI, SBP, the history of smoking and drinking, the duration of diabetes mellitus, HbA1c, FPG, PPG, LDL-C, Cre, C-reactive protein (CRP), uric acid (UA). Based on the ROC curve, the 11.275 μg/min of UAER was the best numerical value to predict the risk of CHD in patients with T2DM. Area under the curve was 0.799, sensitivity was 65.1%, and specificity was 82.9%.

CONCLUSION

Microalbuminuria in patients with T2DM is another risk factor for CHD. Microalbuminuria is significantly positively correlated with the severity of coronary atherosclerosis. An UAER value of 11.275 μg/min can be used to predict the risk of CHD in patients with T2DM.

Cardiovascular disease, SCI and exercise: unique risks and focused countermeasures

PURPOSE

To summarise the spinal cord injury (SCI) specific profile of three cardiovascular disease risk factors (CVD): fasting dyslipidaemia, postprandial lipidaemia and vascular inflammation and to summarise exercise prescriptions that may attenuate each.

METHOD

NA.

RESULTS

NA.

CONCLUSIONS

At least three CVD risk factors have unique profiles in the SCI population. Fasting dyslipidaemia is characterised in the SCI population by depressed HDL cholesterol and normal or low total cholesterol. In the post-prandial state, persons with SCI exhibit an exaggerated triglyceride rise and delayed clearance compared to non-disabled persons. Finally, vascular inflammation, as indexed by C-reactive protein, is markedly elevated in SCI. Exercise may improve each, although the specific prescriptions differs. Fasting dyslipidaemia responds to 8 weeks of moderate intensity aerobic exercise performed 5 days weekly for 30 min daily. Post-prandial lipaemia treatment requires daily moderate or vigorous aerobic exercise, as the effect dissipates day by day. The daily exercise duration is proportional to fitness level, with total caloric expenditure emphasised rather than time. Finally, attenuating vascular inflammation in non-disabled persons requires moderate or vigorous exercise performed for ≥12 months, 5 days weekly for ≥45 min; with aerobic exercise plus resistance training more effective than aerobic exercise alone.

Increased levels of C‐reactive protein and interleukin‐6 in hyperhomocysteinemic subjects

OBJECTIVE

Elevated plasma homocysteine concentration is considered to be an independent risk factor for cardiovascular disease. However, the mechanisms by which hyperhomocysteinemia are related to vascular disease are unclear. High-sensitivity C-reactive protein (CRP), a marker of inflammation, has been reported to be an independent predictor of future myocardial infarction among clinically healthy individuals. Interleukin (IL)-6 is a regulator of CRP and has a key role in initiation of inflammation. The aim of this study was to investigate whether individuals with increased plasma homocysteine concentrations have altered levels of serum CRP and IL-6.

MATERIAL AND METHODS

Serum concentrations of CRP and IL-6 were measured in 39 individuals with hyperhomocysteinemia and in 39 control subjects matched for gender, age and body mass index (BMI). In addition, the inflammatory effect of IL-6 on peripheral blood mononuclear cells was measured.

RESULTS

Compared to controls, hyperhomocysteinemic subjects have elevated serum levels of CRP and IL-6 (p < or =0.001 and p < 0.005, respectively). Importantly, this raised level of IL-6 was also seen in hyperhomocysteinemic individuals without accompanying hypercholesterolemia or cardiovascular disease. IL-6 increased the release of monocyte chemoattractant protein-1 from peripheral blood mononuclear cells, with particularly enhancing effects in cells from patients with hyperhomocysteinemia.

CONCLUSIONS

These data suggest that enhanced inflammation may be associated with homocysteine-related cardiovascular disease, possibly involving IL-6-related mechanisms.

Low-grade inflammation can partly explain the association between the metabolic syndrome and either coronary artery disease or severity of peripheral arterial disease: the CODAM study

BACKGROUND

Low-grade inflammation has been hypothesized to underlie the coronary artery disease (CAD) risk associated with the metabolic syndrome, but the evidence is not conclusive. For peripheral arterial disease (PAD; as measured by the ankle-arm index), this association has not been studied before. The aim was to study whether the association between the metabolic syndrome and CAD or the severity of PAD can be explained by low-grade inflammation.

METHODS

The Cohort study Diabetes and Atherosclerosis Maastricht population includes 574 subjects, with an increased risk of type 2 diabetes, of whom 560 were included in the analyses (343 males; age: 59.5 +/- 7.0 years). The inflammation markers that were measured were C-reactive protein, interleukin 6, soluble vascular cell adhesion molecule-1, soluble intercellular adhesion molecule-1 and serum amyloid A. All analyses were adjusted for age, sex and smoking.

RESULTS

Logistic regression showed that the metabolic syndrome was significantly associated with CAD [odds ratio (OR) = 1.86, 95% CI: 1.21; 2.84, P = 0.004]. Further adjustment for inflammatory status, as captured in a combination of the inflammation markers (using an averaged Z-score), resulted in significant associations of both the metabolic syndrome and inflammatory status with CAD [OR(metabolic syndrome) (95% CI) = 1.58 (1.01; 2.46), P = 0.044; OR(inflammation) (95% CI) = 1.59 (1.14; 2.21), P = 0.007]. Linear regression analysis showed similar results for the ankle-arm index.

CONCLUSIONS

The association between the metabolic syndrome, on the one hand, and prevalence of CAD or the severity of PAD, on the other, can be partly but not completely, 26% and 29% respectively, explained by low-grade inflammation.

Are C-reactive protein and homocysteine cardiovascular risk factors in obese children and adolescents?

BACKGROUND

Several prospective epidemiological studies have demonstrated that high-sensitivity C-reactive protein (hsCRP) and plasma homocysteine (hcy) are predictors of future coronary events among healthy men and women. The aim of the present study was therefore to investigate a possible relationship between hsCRP, hcy levels and body mass index (BMI), relative weight (RW), serum leptin levels, and cardiovascular risk factors in obese children and adolescents.

METHODS

The study involved 28 obese children and adolescents (13 girls, 15 boys; BMI>95 per thousand for age and sex), 4.5-15 years of age (mean 10.7 +/- 0.6 years), who attended hospital for a basic obesity check-up. The association between hsCRP, hcy levels and BMI, RW, serum leptin levels, and cardiovascular risk factors such as blood pressure (BP), lipid profile, serum fasting insulin levels, and insulin resistance indexes, was investigated.

RESULTS

Serum hsCRP level was positively correlated with BMI (r = 0.512, P < 0.01), RW (r = 0.438, P < 0.05), systolic and diastolic BP (r = 0.498, P < 0.01), serum leptin levels (r = 0.457, P < 0.05), but not with serum lipid, glucose, fasting insulin, plasma hcy levels or insulin resistance indexes. For hcy level, in contrast, no correlation was found with BMI, RW, systolic and diastolic BP, serum lipid levels, leptin, hsCRP, glucose, fasting insulin levels, or insulin resistance indexes.

CONCLUSIONS

hsCRP is correlated with BMI, RW, BP and leptin, which are risk factors for coronary heart disease, which supports the relationship between obesity, inflammation and atherosclerosis. hsCRP in childhood obesity might be a useful index to predict possible atherosclerotic events.

Associations of resistin with inflammation and insulin resistance in patients with type 2 diabetes mellitus

OBJECTIVE

Resistin has been linked to obesity, type 2 diabetes, inflammation and atherosclerosis but the results of animal and human studies have been at variance. The purpose of this study was to investigate the potential roles of resistin in patients with type 2 diabetes and to evaluate the correlation between resistin and markers of obesity, inflammation, insulin resistance, metabolic parameters, diabetes control and complications.

MATERIAL AND METHODS

Fasting resistin, leptin, insulin, glucose, HbA1c, full lipid profile, C-reactive protein (CRP) (high sensitivity assay) and complete blood count were determined in 135 patients with type 2 diabetes. Univariate regression and multivariate logistic regression analyses were used to relate resistin with indices of obesity, inflammation, insulin resistance (homeostasis model, HOMA), insulin sensitivity, diabetic control, coronary heart disease (CHD) and degree of microalbuminuria.

RESULTS

Resistin showed significant (p<0.05) correlations with body mass index (BMI) "(Spearman r=0.67), waist circumference (r=0.54), fasting insulin (0.51), insulin sensitivity (r=-0.29), HOMA (r=0.30), leptin (r=0.39), CRP (r=0.29), white cell count (r=0.25) and lipid parameters but showed no significant correlation with glucose and HbA1c. Partial correlation analysis, with correction for BMI, abolished the correlation of resistin with insulin sensitivity and HOMA but not with the white cell count. When confounding factors were fixed using multiple logistic regression, resistin was not independently associated with CHD (odds ratio=1.05, p=0.08) and degree of microalbuminuria (odds ratio=1.06, p=0.24).

CONCLUSIONS

Resistin showed significant BMI-dependent associations with insulin resistance and factors linked with obesity and inflammation in patients with type 2 diabetes. Resistin may represent a link between obesity and insulin resistance via pro-inflammatory pathways.

Associations of apolipoprotein E polymorphism with low-density lipoprotein size and subfraction profiles in Arab patients with coronary heart disease

The APOE gene locus has 3 major alleles, E3, E4 and E2, which variably influence coronary heart disease (CHD) risk. Plasma low-density lipoprotein (LDL) profile, another major CHD risk factor, is characterized on the basis of size and density into 2 main patterns: large buoyant LDL and small dense LDL. The latter has also been linked with increased CHD risk. This study investigates associations of specific APOE allelic patterns with LDL size and subfraction profiles in patients with CHD and healthy control subjects. We recruited 2 groups of male subjects: (A) 65 apparently healthy control subjects, median age, 39.0 years (range, 25.0-60.0 years); (B) 50 patients with CHD, median age, 54.0 years (range, 40.0-76.0 years). APOE genotypes were determined by validated polymerase chain reaction-restriction fragment length polymorphism methods, and LDL size and subfractions were assessed by a high-resolution, nongradient polyacrylamide gel electrophoresis technique (LIPOPRINT, Quantimetrix, Redondo Beach, CA). Lipid and other biochemical analyses were done by autoanalyzer techniques. The associations of specific APOE alleles and genotypes with LDL size and subfraction patterns were then assessed. As expected, patients with CHD had a worse atherogenic lipoprotein profile (waist-hip ratio, LDL, uric acid, and apolipoprotein B) than the controls. APOE genotype and allele frequencies were similar for both groups. In either group, median percent large buoyant LDL (pattern A) was greater in controls (51.0% vs 46.5%, P<.001) and percent small dense LDL (pattern B) was greater with CHD (9.0% vs 3.0%, P<.001). The latter also had smaller median particle size (26.5 vs 26.9 nm, P<.001). In controls, percent LDL pattern B was significantly lower with APOE2 than with APO non-E2 (4.0% vs 0.0%, P<.05); in patients with CHD, E2 patients had smaller particle size, and pattern B was significantly lower with non-E2 than with E2 (15.0 vs 8.0, P<.05). With respect to E4, control non-E4 had a smaller median percent LDL pattern B than E4; otherwise, there were no significant findings in relation to APOE type and LDL size and subfractions in both subject groups. These results confirm observations in other populations of increased levels of small dense LDL in patients with CHD. Although the APOE allelic pattern, especially APOE2, could be related to LDL subfraction profiles in control subjects, such associations could not be demonstrated in those with CHD.

Soluble CD40 ligand levels in otherwise healthy subjects with impaired fasting glucose

Unlike diabetes mellitus and impaired glucose tolerance, it is not clear whether the subjects with impaired fasting glucose (IFG) are at increased risk of atherosclerosis and cardiovascular diseases. The CD40-CD40 ligand interaction is involved in the mechanism of atherosclerosis. We investigated whether soluble CD40L (sCD40L) as well as high sensitive C-reactive protein (hsCRP) levels are increased in subjects with IFG having no confounding factors for inflammation or atherosclerosis. Twenty four IFG subjects with no additional disorders and 40 appropriate healthy controls were studied. sCD40L and hsCRP levels in the IFG and control groups were similar. Blood pressures, total and LDL-cholesterol, and triglyceride levels were also similar, whereas HDL-cholesterol was lower and HOMA-IR indexes were higher in the IFG group. Though the sample size was small, the present data show that sCD40L seems not to alter in subjects with IFG suggesting that it might not be an independent risk factor for atherosclerosis.

C-reactive protein and cardiovascular disease in people with diabetes: high-sensitivity CRP testing can help assess risk for future cardiovascular disease events in this population

Having both diabetes and an elevated C-reactive protein (CRP) level compounds one's risk of developing cardiovascular disease, for which people with diabetes are at particularly high risk. CRP is both a biomarker for infectious and noninfectious disorders associated with inflammation and a risk factor for such conditions. Many researchers now believe that the protein also plays a role in the disease processes. The American Heart Association and the Centers for Disease Control and Prevention recently defined three cardiovascular risk categories relative to CRP levels. This article reviews the relevant literature and explores how CRP levels can be used in cardiovascular disease risk assessment, prevention, and treatment.

Ethnicity and diabetic heart disease

Ethnicity is a complex yet important construct and an independent risk factor for diabetic heart disease (DHD) with paramount clinical significance. Clinicians should try to better understand the role of ethnicity through more questions. The risk of DHD is modified by ethnicity through more questions. The risk of DHD is modified by ethnicity, and its management may require a culturally sensitive individualized approach. Findings from Caucasian populations cannot be fully extrapolated to other ethnic groups, thereby emphasizing the importance of future research with ethnicity-based threshold for obesity. Available limited data support the interaction between genetic predisposition, environmental risk, and lifestyle choices and disparities based on ethnicity as the likely cause for ethnic variations in DHD.

Vascular effects of TZDs: New implications

The incidence of diabetes, now affecting more than 170 million individuals is growing rapidly. Type 2 diabetes, which accounts for 90% of all diabetes cases, is associated with increased cardiovascular morbidity and mortality. Thiazolidinediones (TZDs), used for the treatment of patients with type 2 diabetes improve insulin sensitivity and endothelial dysfunction and exert beneficial effects on the lipid profile by activating the peroxisome proliferator-activated receptor gamma (PPAR-gamma). Moreover, a large body of evidence indicates that TZDs exhibit antiatherogenic effects independent of their antidiabetic and lipid-lowering properties by modulating inflammatory processes. This review will focus on the role of PPAR-gamma agonists in the vessel wall and summarize their effects on C-reactive protein (CRP), plasminogen activator inhibitor type-1 (PAI-1), matrix metalloproteinase-9 (MMP-9), adiponectin and ATP-binding cassette transporter A1 (ABCA1) and their implications for treatment of advanced stages of atherosclerosis, particularly in a setting of type 2 diabetes.

Adiponectin, insulin resistance and clinical expression of the metabolic syndrome in patients with Type 2 diabetes

BACKGROUND

Obesity and the metabolic syndrome have emerged as clinical and public health crises in many populations, but not all obese patients have the syndrome. As adipocytes produce several adipokines that modulate insulin action as well as glucose and lipid metabolism, we postulate that estimation of adipokines may be useful addition to the criteria used to identify obese individuals with the metabolic syndrome.

OBJECTIVE

To evaluate the determinants and associations of plasma adiponectin in relation to the metabolic syndrome in patients with Type 2 diabetes.

DESIGN

Cross-sectional study.

SETTING

General Teaching Hospital.

PATIENTS

One hundred and thirty five (57 M, 78 F) patients with Type 2 diabetes mellitus.

MEASUREMENTS

Adiponectin, leptin, high-sensitivity C-reactive protein (hs-CRP), fasting plasma insulin, glucose, glycated hemoglobin and full lipid profile. Patients were classified on the basis of the degree of adiposity, insulin resistance (IR) (homeostasis model assessment of insulin resistance (HOMA-IR)) and the number of the American Heart Association and the National Heart, Lung and Blood Institute criteria of the metabolic syndrome.

RESULTS

Adiponectin levels were inversely correlated with age, indices of obesity, IR and hs-CRP. Overweight/obese and non-obese insulin-sensitive patients had significantly higher (P<0.05) adiponectin levels than those with IR despite similar body mass index and waist circumference. Therefore, within each category of obesity stratification, lower adiponectin levels were associated with IR. Adiponectin showed stepwise decrease with increasing number of the criteria for diagnosis of the metabolic syndrome. Using multiple logistic regression, the odds ratio of the metabolic syndrome as predicted by adiponectin was 0.73 (95% confidence interval 0.53-0.96; P=0.04). At cutoff point of 18 ng/ml, the diagnostic sensitivity and specificity of adiponectin for the metabolic syndrome were 83 and 65%, respectively, in male patients and 92 and 41%, respectively, in female patients. Receiver operating characteristic analysis showed that adiponectin had significantly higher area under the curve compared with leptin, leptin:adiponectin ratio and triglycerides for the detection of the metabolic syndrome.

CONCLUSIONS

In patients with Type 2 diabetes, adiponectin concentrations are closely related to IR and the components of the metabolic syndrome. Adiponectin concentration may be a useful addition to the criteria used for identifying obese subjects with the metabolic syndrome.

Sialic acid in cardiovascular diseases

Sialic acid, the acylated derivatives of 9-carbon sugar neuraminic acid, present as terminal component of oligosaccharide chains of many glycoproteins and glycolipids, has been recognized to be involved in the regulation of a great variety of biological phenomena. Studies have shown that serum sialic acid predicts both coronary heart disease and stroke mortality and reflects the existence or activity of an atherosclerotic process. Most of the studies have shown an elevation in serum sialic acid concentration in coronary heart disease and a positive correlation between the raised serum sialic acid and the severity of the coronary lesions is observed. However, a few contradictory reports are also available. Racial differences in serum sialic acid have also been reported and correlated with international differences in the prevalence of atherosclerosis. Reduced sialic acid content of platelets, erythrocytes and lipoproteins may play important role in the pathogenesis of atherosclerosis. Elucidation of the mechanism of alternation in sialic acid concentration may throw more light on its potential clinical utility. Hence more studies are needed to designates sialic acid as a cardiovascular risk factor/marker.

C-reactive protein as a predictor of total arteriosclerotic outcomes in type 2 diabetic nephropathy

BACKGROUND

The inflammatory marker C-reactive protein (CRP) has been found in most, but not all, prospective studies to be associated with future cardiovascular outcomes. However, CRP has not been tested in the high-cardiovascular risk population of type 2 diabetic nephropathy.

METHODS

We studied the independent relationship between CRP and the subsequent development of incident or recurrent arteriosclerotic outcomes (primary) and congestive heart failure events (secondary) in 1560 individuals with diabetic nephropathy, overt proteinuria, and hypertension enrolled in the prospective Irbesartan Diabetic Nephropathy Trial.

RESULTS

Traditional cardiac risk factors were highly prevalent, CRP levels were high overall [quintiles (mg/L) 1st, 0 to 1.2; 2nd, 1.3 to 2.5; 3rd, 2.6 to 5.0; 4th, 5.1 to 10.0; and 5th, >10), and subsequent cardiovascular events were very common. A univariate relationship existed between CRP and total arteriosclerotic outcomes (P < 0.0001). However, after adjusting for study intervention and traditional risk factors, the relationship no longer remained. In fact, controlling for previous cardiovascular disease alone caused the association to become nonsignificant. The secondary analysis found a significant univariate relationship between CRP and congestive heart failure events (P= 0.007) that persisted in multivariate analyses (P= 0.006). However, this relationship was confined to the highest CRP quintile [RR (95% CI) 2.0 (1.27, 3.16)].

CONCLUSION

In diabetic patients with nephropathy, CRP does not add predictive information above and beyond that provided by traditional established risk factors. Whether this holds true for other populations with similar risk burdens is an important public health question that should be addressed. A secondary finding of a link between CRP and congestive heart failure requires further confirmation.

Association of acute-phase reactants with arterial stiffness in patients with type 2 diabetes mellitus

BACKGROUND

The relationship between chronic low-grade inflammation and atherosclerotic progress in patients with diabetes mellitus has not been confirmed. We determined whether acute-phase reactants are associated with arterial stiffness in diabetic patients.

METHODS

Relationships of blood inflammatory markers [high-sensitivity C-reactive protein (CRP), amyloid A protein (SAA), sialic acid, fibrinogen and white blood cells (WBC)] with atherosclerosis were investigated in a cross-sectional study using 114 subjects with type 2 diabetes. The degree of atherosclerosis was evaluated by arterial stiffness measured using cardio-ankle vascular index (CAVI), a new index of arterial stiffness, which is compatible with conventional aortic pulse-wave velocity.

RESULTS

CRP, SAA, sialic acid, fibrinogen and WBC showed significant correlations with CAVI. CAVI was significantly higher in the highest tertile of sialic acid, fibrinogen and WBC compared with the lowest tertile or lowest and middle tertiles. This association was independent of age, sex and smoking. By logistic regression analysis, the highest levels of these acute-phase reactants showed increased risk of high CAVI, while CRP and SAA were not associated with an increased risk in this analysis. CAVI was also significantly correlated with duration of diabetes, blood pressure and serum total cholesterol.

CONCLUSIONS

Acute-phase reactants, such as CRP, SAA, sialic acid, fibrinogen and WBC, are associated with arterial stiffness in patients with type 2 diabetes mellitus.

Association of plasma homocysteine with serum interleukin-6 and C-peptide levels in patients with type 2 diabetes

Hyperhomocysteinemia is an independent risk factor for atherosclerotic disease. Because serum markers of inflammation and the metabolic syndrome are also associated with atherosclerotic disease and insulin resistance, we investigated whether plasma homocysteine (Hcy) levels were associated with serum markers of inflammation and factors of metabolic syndrome in 223 elderly patients with type 2 diabetes mellitus. The levels of plasma Hcy and serum interleukin-6 (IL-6), high-sensitivity C-reactive protein, and C-peptide were measured. The C677T mutation of methylenetetrahydrofolate reductase (MTHFR) gene was detected using the polymerase chain reaction-restriction fragment length polymorphism method. The number of abnormal metabolic factors (presence of diabetes, blood pressure > or =130/85 mm Hg, triglycerides > or =150 mg/dL, high-density lipoprotein cholesterol <35 mg/dL (men) or <39 mg/dL (women), or body mass index >25 kg/m 2 ) was assessed. Elevated plasma Hcy levels correlated significantly with serum IL-6 ( r = 0.25, P < .001), C-peptide ( r = 0.22, P < .01), and the number of abnormal metabolic factors ( r = 0.20, P < .01), but not with C-reactive protein. Multiple linear regression analysis revealed that log-transformed IL-6, serum C-peptide, vitamin B12 , and creatinine were significant determinants of plasma Hcy levels. The correlation between Hcy and IL-6 levels was strongest in those with TT genotype of C677T MTHFR among 3 genotypes. The association between plasma Hcy and serum IL-6 levels supports the hypothesis that the activation of innate immunity is involved in the pathogenesis of arteriosclerosis in patients with diabetes mellitus who are homozygous for the TT genotype of C677T MTHFR.

Thematic review series: The Immune System and Atherogenesis. Lipoprotein-associated inflammatory proteins: markers or mediators of cardiovascular disease?

In humans, a chronically increased circulating level of C-reactive protein (CRP), a positive acute-phase reactant, is an independent risk factor for cardiovascular disease. This observation has led to considerable interest in the role of inflammatory proteins in atherosclerosis. In this review, after discussing CRP, we focus on the potential role in the pathogenesis of human vascular disease of inflammation-induced proteins that are carried by lipoproteins. Serum amyloid A (SAA) is transported predominantly on HDL, and levels of this protein increase markedly during acute and chronic inflammation in both animals and humans. Increased SAA levels predict the risk of cardiovascular disease in humans. Recent animal studies support the proposal that SAA plays a role in atherogenesis. Evidence is accruing that secretory phospholipase A(2), an HDL-associated protein, and platelet-activating factor acetylhydrolase, a protein associated predominantly with LDL in humans and HDL in mice, might also play roles both as markers and mediators of human atherosclerosis. In contrast to positive acute-phase proteins, which increase in abundance during inflammation, negative acute-phase proteins have received less attention. Apolipoprotein A-I (apoA-I), the major apolipoprotein of HDL, decreases during inflammation. Recent studies also indicate that HDL is oxidized by myeloperoxidase in patients with established atherosclerosis. These alterations may limit the ability of apoA-I to participate in reverse cholesterol transport. Paraoxonase-1 (PON1), another HDL-associated protein, also decreases during inflammation. PON1 is atheroprotective in animal models of hypercholesterolemia. Controversy over its utility as a marker of human atherosclerosis may reflect the fact that enzyme activity rather than blood level (or genotype) is the major determinant of cardiovascular risk. Thus, multiple lipoprotein-associated proteins that change in concentration during acute and chronic inflammation may serve as markers of cardiovascular disease. In future studies, it will be important to determine whether these proteins play a causal role in atherogenesis.

Plasma leptin concentration in patients with Type 2 diabetes: relationship to cardiovascular disease risk factors and insulin resistance

AIMS

The aim of this study was to evaluate the relationship of obesity, leptin, insulin resistance and C-reactive protein (CRP) with coronary heart disease (CHD) risk factors in patients with Type 2 diabetes mellitus (DM) with CHD compared with those with Type 2 DM without CHD.

METHODS

Leptin, CRP (high sensitivity assay), fasting plasma insulin, glucose, HbA(1c) and full lipid profile were determined in 58 Type 2 diabetic patients with CHD and 87 Type 2 DM patients without CHD.

RESULTS

were compared between those with and without CHD. Univariate correlation as well as logistic regression analyses were used to relate these markers with traditional CHD risk factors.

RESULTS

Leptin showed significant correlations with BMI (r = 0.59; P < or = 0.0001), waist circumference (r = 0.45; P < 0.0001), CRP (r = 0.36; P < 0.0001), and fasting insulin (r = 0.53; P < 0.0001) as well as with systolic (r = 0.23; P = 0.007) and diastolic (r = 0.23; P = 0.007) blood pressure. However, when those with and without CHD were compared only age (P < 0.0001), duration of diabetes (P < 0.001) and degree of microalbuminuria (P = 0.02) were significantly higher in patients with CHD. Leptin (P = 0.49), CRP (P = 0.19) and lipid parameters were not significantly different between the two groups.

CONCLUSION

Our study confirms a relationship between leptin and CRP with CHD risk factors. The lack of significant difference when patients with and without CHD are compared may be due to the potential confounding effects of treatment with aspirin and statins.

Augmentation de la concentration plasmatique de la protéine C-réactive dans le diabète de l’enfant et de l’adulte jeune

OBJECTIVE

To investigate whether high sensitivity C-reactive protein (hs CRP) levels are elevated in young type 1 diabetic patients and to determine the relationships with age, degree of metabolic control determined by glycated hemoglobin (HbA1c), blood lipids, and subclinical complications.

METHODS

High sensitivity CRP was determined in young type 1 diabetic patients and in healthy controls. Blood lipids and HbA1c were also determined. The patients were divided into 2 groups. In group A, patients were free from subclinical complications (retinopathy, nephropathy and neuropathy) and in group B, patients had at least one subclinical complication.

RESULTS

The hs CRP concentrations were significantly higher in the 126 diabetic patients (55 girls and 71 boys) than in the 52 controls (2.6+/-4mg/L vs 0.7+/-0.7mg/L; p<0.001). This difference persisted when comparing the normal subjects with the 81 patients of group A (2.0+/-3.1mg/L; p<0.01) and the 45 patients of group B (3.6+/-5.1mg/L; p<0.001). The hs CRP concentrations were significantly correlated with total cholesterol, total cholesterol/HDL-cholesterol ratio, and LDL cholesterol for the 2 groups of patients. In the patients of group A, significant correlations were observed between hs CRP and age or duration of diabetes. No correlation was observed between hs CRP levels and glycaemia, HbA1c and HDL-cholesterol in the two groups of patients.

CONCLUSION

Levels of hs CRP were 3-fold greater in diabetic patients without complications than in controls and 5-fold greater in diabetic patients with subclinical complications. High sensitive CRP therefore appears to be an interesting indicator of the risk for developing complications.

Long-term efficacy of soy-based meal replacements vs an individualized diet plan in obese type II DM patients: relative effects on weight loss, metabolic parameters, and C-reactive protein

BACKGROUND

Achieving significant weight loss and glycemic control in diabetic patients remains a challenging task.

OBJECTIVE

This study compared the effects of a soy-based meal replacement (MR) plan vs an individualized diet plan (IDP; as recommended by the American Diabetes Association) on weight loss and metabolic profile.

DESIGN/SUBJECTS

A total of 104 subjects were randomized prospectively to the two treatments for a total of 12 months.

RESULTS

In all, 77 of the 104 subjects completed the study. Percentage weight loss in MR group (4.57+/-0.81%) was significantly greater (P<0.05) than in IDP group (2.25+/-0.72%). Fasting plasma glucose was significantly reduced in MR group (126.4+/-4.9 mg/dl) compared with IDP group (152.5+/-6.6 mg/dl, P<0.0001) at 6 months but not at 12 months. Controlling for baseline levels, hemoglobin Alc level improved by 0.49+/-0.22% for those receiving MR when compared to IDP group (P<0.05). A greater number of subjects in MR group reduced their use of sulfonylureas (P<0.0001) and metformin (P<0.05) as compared to IDP group. High-sensitivity C-reactive protein (hs-CRP) decreased -26.3% (P = 0.019) in MR group compared to -7.06% (P = 0.338) in IDP group at 6 months. Similar changes were observed at 12 months with MR groups, with hs-CRP decreasing by -25.0% (P = 0.019) compared to -18.7% (P = 0.179) in IDP group.

CONCLUSION

This study demonstrates that MR is a viable strategy for weight reduction in diabetic patients, resulting in beneficial changes in measures of glycemic control and reduction of medications.

Homocysteine as a risk factor for coronary heart diseases and its association with inflammatory biomarkers, lipids and dietary factors

The causal relation of total Homocysteine (tHcy) to coronary heart diseases (CHD) is unclear. In vitro studies suggest a proinflammatory effect. Among 32,826 women from the Nurses' Health Study who provided blood samples in 1989-1990, 237 CHD events were documented during 8 years of follow-up. The cases (1:2) were matched to controls on age, smoking, and month of blood draw. Plasma tHcy was inversely associated with blood levels of folate (partial r = -0.3, P < 0.0001) and B1(2) (r = -0.2, P < 0.0001) and with dietary intake of folate (r = -0.1, P < 0.01) and B(2) vitamin (r = -0.1, P = 0.01). tHcy was positively associated with soluble tumor necrosis receptor (sTNF-R) 1 and 2 (partial r = 0.2, P < 0.0001). In a multivariate model adjusted for age, smoking, BMI, parental history, hypertension, diabetes, postmenopausal hormone use, physical activity and alcohol intake, the relative risk of CHD between the extreme quartiles of tHcy was 1.66 (95% CI; 1.05-2.64, P trend = 0.02). The association was not appreciably attenuated after further adjustments for sTNF-R1, sTNF-R2, CRP, or Total Cholesterol:/HDL-c ratio. tHcy is an independent risk predictor of CHD and modestly associated with TNF-receptors. However, the inflammatory biomarkers measured could not explain its role in CHD.

Age-dependent relation of serum sialic acid concentration to aortic pulse wave velocity in type 2 diabetes

OBJECTIVE

The purpose of this study was to determine whether age affects the significance of serum sialic acid concentration as a marker of atherosclerosis in patients with diabetes.

METHODS

In this cross-sectional study, we investigated the relationship of serum sialic acid concentration to aortic pulse wave velocity (a-PWV) and the effects of age on this relationship in patients with type 2 diabetes.

RESULTS

In the elderly (70 years or over) diabetic patients, a-PWV showed a significant positive correlation with serum sialic acid. This relationship was also significant after adjustment for age, duration of diabetes, body mass index, systolic blood pressure, LDL cholesterol, HDL cholesterol and fibrinogen levels. In elderly diabetic patients, a-PWV also showed a significant positive correlation with age and duration of diabetes and a significant negative correlation with serum HDL cholesterol level. On the other hand, in the younger (31-60 years) diabetic patients, there was no significant correlation between serum sialic acid level and a-PWV, while a-PWV showed significant positive correlations with age, duration of diabetes and plasma fibrinogen level.

CONCLUSIONS

Serum sialic acid level reflects atherosclerosis in elderly diabetic patients but not in younger diabetic patients. This may explain recent controversial findings regarding the relationship between serum sialic acid level and incidence of coronary heart disease in diabetes.

Increase in hepatic mRNA expression of coagulant factors in type 2 diabetic model mice

AIM

The purpose of the study is to investigate whether hypercoagulation in diabetes is observed not only in increased plasma levels of the coagulative factors but also in increased hepatic mRNA levels.

MATERIALS AND METHODS

The age-related changes of coagulation factors were determined using KK and KK-A(y) mice as a model for human type 2 diabetes mellitus. Expression of the alpha-, beta- and gamma-chains of fibrinogen-mRNA and prothrombin-mRNA from the mouse liver was examined by reverse transcription-polymerase chain reaction (RT-PCR).

RESULTS

Hemoglobin A(1c) (HbA(1C)), plasma fibrinogen, triglyceride and insulin levels increased apparently, especially in KK-A(y) mouse at 4 months old. The mRNA levels of gamma-chain of fibrinogen significantly increased at 3 and 4 months of age in both mice. The mRNA levels of alpha- and beta-chains of fibrinogen and prothrombin were significantly increased in 4-month-old KK-A(y) mouse.

CONCLUSIONS

These results suggest that the increase in hepatic mRNA expression of coagulant factors contributes to the hypercoagulable state in type 2 diabetic mice.

Plasma homocysteine and inflammation in elderly patients with cardiovascular disease and dementia

Increased levels of plasma total homocysteine (tHcy) may play a role in both cardiovascular diseases (CVD) and old-age dementias via enhancement of vascular inflammation. However, the association between plasma tHcy and serum C-reactive protein (sCRP), taken as a marker of low-grade inflammation, is still uncertain. We investigated this association in normal aging, CVD, and dementia, and examined whether it was modified by the presence of two major comorbid diseases of older age: chronic obstructive pulmonary disease (CPOD) and peptic ulcer (PU). Six hundred-twenty-seven individuals aged > or = 65 yr (74+/-7 yr) were selected for this study: 373 healthy controls; 160 patients with CVD but no evidence of comorbid diseases (CVD+/comorbidity-); 46 patients with CVD and concurrent CPOD and/or PU (CVD+/comorbidity+); and 48 patients with dementia. A positive association between plasma tHcy and serum CRP, independent of several confounders (socio-demographic status, known tHcy and sCRP determinants, inflammation markers, traditional vascular risk factors), was found for CVD+/comorbidity+ (p=0.001; not affected by dementia type) and dementia (p=0.001; not affected by dementia type), but not for CVD+/comorbidity- and controls. The results suggest that the association between plasma tHcy and sCRP is more an aspecific reflection of poor health than a specific correlate of vascular inflammation.

C-reactive protein and incident cardiovascular events among men with diabetes

OBJECTIVE

Several large prospective studies have shown that baseline levels of C-reactive protein (CRP) are an independent predictor of cardiovascular events among apparently healthy individuals. However, prospective data on whether CRP predicts cardiovascular events in diabetic patients are limited so far.

RESEARCH DESIGN AND METHODS

To investigate the association between plasma CRP levels and incidence of cardiovascular events among men with type 2 diabetes, we followed prospectively a cohort of 746 American men aged 46-81 years who were free of cardiovascular diseases at the time of blood collection in 1993-1994.

RESULTS

During an average of 5 years of follow-up (3,986 person-years), we identified 103 incident cardiovascular events (18 myocardial infarction, 70 coronary artery bypass grafting or angioplasty, and 15 stroke), confirmed by medical records. After adjustment for age, BMI, smoking, alcohol consumption, physical activity, family history of coronary heart disease, history of high blood pressure, history of high serum cholesterol, aspirin use, and fasting status as well as for fibrinogen, creatinine, HbA(1c), and non-HDL cholesterol levels, CRP remained significantly associated with an increased risk of cardiovascular events. The relative risks for quartiles were 1.00, 1.51, 2.52, and 2.62 (95% CI: 1.29-5.32; P for trend: 0.011). We observed no effect modifications by plasma levels of LDL cholesterol, HDL cholesterol, non-HDL cholesterol, apolipoprotein B, HbA(1c), and fibrinogen or by BMI.

CONCLUSIONS

High plasma levels of CRP were associated with an increased risk of incident cardiovascular events among diabetic men, independent of currently established lifestyle risk factors, blood lipids, and glycemic control.

Xuezhikang decreases serum lipoprotein(a) and C-reactive protein concentrations in patients with coronary heart disease

BACKGROUND

Increased serum lipoprotein(a) [Lp(a)] and high-sensitivity C-reactive protein (hsCRP) concentrations are independent risk factors for coronary heart disease (CHD). Xuezhikang, an extract of cholestin, effectively lowers fasting cholesterol and triglyceride concentrations. We studied whether xuezhikang lowered Lp(a) and hsCRP concentrations.

METHODS

We randomly divided 60 CHD patients into two groups to receive xuezhikang (1200 mg daily) or placebo for 6 weeks. The fasting hsCRP concentration and the postprandial changes of serum lipid concentrations at 2, 4, and 6 h after a high-fat meal (800 calories; 50 g of fat) were measured before and after the 6-week protocol.

RESULTS

The two groups had similar baseline fasting lipid and hsCRP concentrations. The postprandial triglyceride and Lp(a) concentrations were significantly increased (P <0.05). After 6 weeks, the fasting and postprandial lipid concentrations decreased significantly in the xuezhikang group, accompanied by a significant reduction in fasting hsCRP concentration (P <0.001). The placebo group had no significant change in lipid concentrations, whereas the fasting serum hsCRP concentration was reduced significantly (P <0.05). The reduction in hsCRP was closely related to the changes in fasting Lp(a) concentration (r = 0.402; P <0.05) and triglyceride area under the curve (r = 0.441; P <0.001).

CONCLUSIONS

Xuezhikang effectively decreased fasting Lp(a) and postprandial triglyceride concentrations, which were associated with reductions of fasting hsCRP concentrations in CHD patients.