hsCRP levels predict CV outcomes in type 2 diabetic patients post-ACS
High-sensitivity C-reactive Protein, Low-Density Lipoprotein Cholesterol, and Cardiovascular Outcomes in Patients with Type 2 Diabetes in the EXAMINE (Examination of Cardiovascular Outcomes With Alogliptin Versus Standard of Care) TrialLiterature - Hwang YC, Morrow DA, Cannon CP, et al. - Diabetes Obes Metab. 2017; published online ahead of print
- During a median duration of 18 months of follow-up, the cumulative incidences of MACE were as follows (P<0.001): 11.5% in patients with baseline hsCRP <1 mg/l, 14.6% in patients with baseline hsCRP: 1-3 mg/l, 18.4% in patients with baseline hsCRP >3 mg/l.
- Compared to patients with baseline hsCRP <1 mg/l, in patients with a baseline hsCRP >3 mg/l, the following adjusted HRs were calculated: 1.42 (95%CI:1.13-1.78; P=0.002) for MACE, 1.40 (95%CI:1.04-1.89; P=0.025) for non-fatal MI, 2.04 (95%CI:1.34-3.11; P<0.001) for HF hospitalization, 1.77 (95%CI:1.29-2.42; P<0.001) for all-cause death.
- The results were independent of treatment group, age, gender, BMI, current smoking, TC, estimated GFR, BP, glycated hemoglobin, and duration of DM.
- The baseline hsCRP concentrations were not independently associated with the individual endpoints of CV death, non-fatal stroke, or urgent revascularization due to unstable angina.
- Patients with average concentrations of hsCRP (1–3 mg/l) had a CV risk comparable to patients with hsCRP concentrations <1 mg/l.
- The cumulative incidences of MACE were (P<0.001): 11.0% in patients with low LDL-c and low hsCRP concentrations, 14.4% in patients with low LDL-c and high hsCRP concentrations, 15.6% in patients with high LDL-c and low hsCRP concentrations, 21.3% in patients with high LDL-c and high hsCRP concentrations.
In T2DM patients at high CV risk with a recent ACS, there is a significant association between baseline hsCRP values and future CV outcomes, independent and additive to the achieved LDL-c level. These results suggest that the measurement of hsCRP levels, in addition to LDL-c, in these patients may be useful to assess their residual CV risk.