Affiliation:
1. Department of Internal Medicine, University Hospital Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro, Brazil
Abstract
Background
The prognostic value of C‐reactive protein (
CRP
) is controversial in type 2 diabetes mellitus. We aimed to assess it in a cohort of high cardiovascular risk diabetic patients.
Methods and Results
CRP
was measured at baseline and during the second year of follow‐up in 616 patients. The primary end points were a composite of total fatal and nonfatal cardiovascular events (
CVE
s), major
CVE
s, and all‐cause and cardiovascular mortalities. Association between baseline and second‐year
CRP
with end points were evaluated by multivariable Cox survival analyses. Baseline median
CRP
was 2.8 mg/L (interquartile range: 1.2–6.0 mg/L), and 47.8% of the patients either increased or persisted with high
CRP
levels during the first 2 years of follow‐up. After a median follow‐up of 8.4 years, 131 total
CVE
s occurred (89 major
CVE
s), and 129 patients died (53 of cardiovascular causes). Baseline and second‐year
CRP
, analyzed as a continuous variable and dichotomized at >3.0 mg/L, were significantly associated with total and major
CVE
s occurrence (with adjusted hazard ratios between 1.22 and 1.34 for increments of 1‐
SD
log of continuous
CRP
, and between 1.47 and 1.89 for dichotomized
CRP
), but not with mortality. Additionally, increasing
CRP
levels or persisting with high levels were associated with a 1.84 (95%
CI
: 1.10–3.06) excess risk of major
CVE
s, independent of baseline
CRP
values.
Conclusions
Baseline and serial changes in
CRP
levels provide cardiovascular risk prediction independent of standard risk factors and glycemic control, and may be useful to refine cardiovascular risk stratification in high‐risk patients with type 2 diabetes mellitus.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
22 articles.
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