CRP Confirmed as Independent Risk Factor for Coronary Heart Disease Death in
Patients With Diabetes

Medscape Cardiology 2006. © 2006 Medscape

". . . [diabetic] patients with hs-CRP levels > 3/0 mg/L had a 1.6-fold higher
CHD mortality rate than patients with hs-CRP </= 3.0 mg/dL... independent of
other risk factors..."

Diabetic patients are known to have a 2- to 4-fold higher risk for coronary
heart disease (CHD) and to have higher levels of high-sensitivity C-reactive
protein (hs-CRP) than people without diabetes, but now, for apparently the
first time, a large study has shown that elevated hs-CRP levels are an
independent risk factor for death from CHD in people with type 2 diabetes.
However, the mortality risk is increased only when hs-CRP levels exceed 3
mg/L, according to the results of a 7-year follow-up study reported by
researchers from Finland.[1]

Minna Soinio, MD, from the Department of Medicine, University of Turku, and
colleagues at the National Public Health Institute, Turku, and the University
of Kuopio, published their findings in the February issue of Diabetes Care.

Dr. Soinio and her colleagues reviewed data from 1045 patients with type 2
diabetes aged 45 to 64 years who were originally enrolled into a study of
atherosclerotic disease in 2 districts of Finland between 1984 and 1989.

Over a 7-year follow-up period, 157 patients died from CHD and 254 had a fatal
or nonfatal CHD event. Mean hs-CRP levels were significantly higher in men who
died of CHD or who had a fatal or nonfatal myocardial infarction (MI) than in
men who did not. Although also higher in women, the difference was not
statistically significant.

Dividing patients according to hs-CRP levels of < 1.0, 1.0-3.0, and > 3.0 mg/L
showed that CHD mortality was highest in the > 3.0 mg/L group (increased ~ 20%
vs < 13% and > 13% in the < 1.0 and 1.0-3.0 mg/L groups, respectively). When
nonfatal MI rates were combined with CHD mortality rates, the resulting
combined risk rates in the < 1.0, 1.0-3.0, and > 3.0 mg/L hs-CRP groups were
23%, 23%, and 28%, respectively.

This means that patients with hs-CRP levels > 3/0 mg/L had a 1.6-fold higher
CHD mortality rate than patients with hs-CRP </= 3.0 mg/dL. The result was
similar (1.8-fold higher CHD mortality rate) when only the patients with no
history of MI were analyzed. The association of increased CHD mortality risk
and hs-CRP > 3 mg/L persisted even when analyses were adjusted for age,
gender, cholesterol levels, duration of diabetes, hemoglobin A1c level,
hypertension, smoking, body mass index, area of residence, or aspirin therapy,
and when patients with levels of hs-CRP > 10 mg/L were excluded.

The independent risk posed by elevated hs-CRP levels in diabetic patients
"suggests that inflammation plays an important role in fatal CHD events also
among this high-risk population," Dr. Soinio and colleagues said. "This might
partly explain why statins and aspirin, in addition to their LDL-lowering and
antiplatelet effects, have had favorable effects in studies on the prevention
of CHD events in patients with type 2 diabetes," they suggested.

Funding info: The research in this article was supported by the Turku
University Central Hospital Research Fund and Julio Vainio Foundation.

Reference
 1.. Soinio M, Marniemi J, Laakso M, et al. High-sensitivity C-reactive
protein and coronary heart disease mortality in patients with type 2 diabetes.
A 7-year follow-up study. Diabetes Care. 2006;29:329-333.
By Linda Brookes, MSc