Low-grade inflammation as a risk factor for cardiovascular events and all-cause mortality in patients with type 2 diabetes
Open accessAbstract
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.
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The 1.8-fold decrease in hsCRP may translate into reduction in residual cardiovascular risk.
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- Authors
- Sharif, S., Van der Graaf, Y., Cramer, M. J., Kapelle, L. J., de Borst, G. J., Visseren, F. L. J., Westerink, J., the SMART study group, van Petersen, R., Dinther, B. G. F., Algra, A., van der Graaf, Y., Grobbee, D. E., Rutten, G. E. H. M., Visseren, F. L. J., de Borst, G. J., Kappelle, L. J., Leiner, T., & Nathoe, H. M.
- Affiliations
- University Medical Center Utrecht (NL)
- Corresponding author
- Westerink, Jan
- ORCID
- Venue
- Cardiovascular Diabetology
- Published
- 2021-11-09
- Volume
- 20
- Issue
- 1
- Pages
- 220-220
- ISSN
- 1475-2840 (ISSN-L)
- PMC
- PMC8579639
- OpenAlex
- W3213397314
- Cited by
- 198
- References
- 32
- Citations by year
- 2026: 30 · 2025: 54 · 2024: 51 · 2023: 37 · 2022: 25 · 2021: 1
- FWCI
- 20.54
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Cardiovascular Diabetology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Keywords
- type 2 diabetes, low-grade inflammation, high-sensitivity C-reactive protein, cardiovascular events, all-cause mortality, vascular death, myocardial infarction, stroke, residual cardiovascular risk
- MeSH terms
- Heart Disease Risk Factors, Aged, Blood Glucose, C-Reactive Protein, Cardiovascular Diseases, Cause of Death, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Inflammation, Lipids, Male, Middle Aged, Netherlands, Prognosis, Prospective Studies, Time Factors, Biomarkers, Incidence, Risk Assessment, Inflammation Mediators
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