Relationship of serum high sensitivity C-reactive protein to metabolic syndrome and microvascular complications in type 2 diabetes
Introduction
Inflammation is a major factor in atherosclerotic disease [1], [2]. The serum levels of high sensitivity C-reactive protein (hsCRP), which is a marker of systemic inflammation and a mediator of atherosclerotic disease, have been correlated with the risk of cardiovascular disease [3], [4], [5], [6], [7] and type 2 diabetes mellitus [8], [9]. A recent report by the American Heart Association/Centers for Disease Control and Prevention (AHA/CDC) indicated that CRP measurements might provide information for a global risk assessment for coronary heart disease beyond that obtained from the established risk factors. CRP is a marker of subclinical inflammation that predicts the occurrence of coronary heart disease in healthy subjects. Hyperglycemia is known to stimulate the release of inflammatory cytokines from various cell types and can lead to the induction and secretion of acute-phase reactants by adipocytes [10], [11], [12]. Several studies have reported that patients with metabolic syndrome (MS) have a higher hsCRP level than those without [13], [14], [15], [16]. This study evaluated the association between the serum hsCRP level and the components of MS, carotid intima-media thickness (IMT) and microvascular complications in type 2 diabetes subjects.
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Subjects
Five hundred and twenty patients were recruited from May 2002 to April 2003. All the patients had no history of ketoacidosis or no ketonuria and were negative for the GAD antibody. The patients with a high hsCRP level (≥10 mg/L) were excluded in order to rule out the effects of other inflammatory disease states. Furthermore, patients with a white blood cell count ≥10,000/μL, leukocytes in a urine sample or a creatinine ≥1.4 mg/dL were also excluded. After careful history taking and physical
Clinical characteristics of subjects according to presence of metabolic syndrome
One hundred and fifty-three patients (56.9%) had MS. Table 1 presents the characteristics of those with and without MS. Consistent with previous studies, the serum hsCRP level was significantly higher in the patients with MS than in those without (p = 0.019). Patients with MS had a higher systolic/diastolic blood pressure (p = 0.006, p = 0.034) than those without. However, there were no significant differences in age, HbA1c, fasting plasma glucose, IMT and 24 h urine albumin excretion (Table 1). Fig. 1
Discussion
CRP measurements have been used for decades to evaluate the level of inflammation. The serum hsCRP levels in diabetic patients are known to be higher than in normal subjects [24], [25]. According to NHANES III (the Third National Health and Nutrition Examination Survey), the mean serum hsCRP concentration in adults over 20 years is 4.14 mg/L [26]. The serum hsCRP level is <10 mg/L in 98% of normal subjects [27]. Sitzer et al. [28] reported that the median hsCRP concentration is 1.135 mg/L in
Acknowledgement
This study was supported by a grant of the Brain Korea 21 project for medical science, Yonsei University.
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