Physicians' Academy for Cardiovascular Education

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) Trial

Literature - Hwang YC, Morrow DA, Cannon CP, et al. - Diabetes Obes Metab. 2017; published online ahead of print


CRP concentrations predict CV risk in primary and in secondary prevention. The predictive value of CRP levels is comparable with that of SBP, TC, and non-HDL-c in primary prevention, whereas in the setting of secondary prevention, higher high-sensitivity (hs)CRP concentrations during the first 72 hours of an ACS have been associated with a higher long-term risk of recurrent CV events [1-3].

In this analysis of the multicenter, randomized, double-blind EXAMINE trial [4], the predictive value of baseline hsCRP in regard to MACE was evaluated in type 2 diabetes (T2DM) patients at high CV risk with a recent ACS, but well treated with statins and good glycemic control. Moreover, it was assessed whether the association of hsCRP levels and CV outcomes was independent of LDL-c levels.

EXAMINE evaluated the efficacy and safety of the DPP-4 inhibitor alogliptin in 5380 T2DM patients who suffered an ACS within 15 to 90 days before randomization. The primary MACE endpoint consisted of CV death, non-fatal MI, and stroke.

Main results


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.


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