TY - JOUR
T1 - Low-grade inflammation as a risk factor for cardiovascular events and all-cause mortality in patients with type 2 diabetes
AU - Sharif, Shahnam
AU - Van der Graaf, Y
AU - Cramer, M J
AU - Kapelle, L J
AU - de Borst, G J
AU - Visseren, Frank L J
AU - Westerink, Jan
N1 - Funding Information:
We gratefully acknowledge the contribution of the SMART research nurses; R.van Petersen (data-manager); B.G.F. Dinther (vascular manager) and the participants of the SMART Study Group: A. Algra MD,PhD; Y. van der Graaf, MD,PhD; D.E. Grobbee, MD,PhD; G.E.H.M. Rutten, MD,PhD, Julius Center for Health Sciences and Primary care; F.L.J.Visseren, MD,PhD, Department of Internal Medicine; G.J. de Borst, MD,PhD, Department of Vascular Surgery; L.J. Kappelle, MD,PhD, Department of Neurology; T. Leiner, MD,PhD, Department of Radiology; H.M. Nathoe, MD,PhD, Department of Cardiology.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/11/9
Y1 - 2021/11/9
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85118918594&partnerID=8YFLogxK
U2 - 10.1186/s12933-021-01409-0
DO - 10.1186/s12933-021-01409-0
M3 - Article
C2 - 34753497
SN - 1475-2840
VL - 20
SP - 1
EP - 8
JO - Cardiovascular Diabetology
JF - Cardiovascular Diabetology
IS - 1
M1 - 220
ER -