Relationship of serum high sensitivity C-reactive protein to metabolic syndrome and microvascular complications in type 2 diabetes

https://doi.org/10.1016/j.diabres.2004.11.014Get rights and content

Abstract

The high sensitivity C-reactive protein (hsCRP) is known to be a sensitive predictor of coronary heart disease and type 2 diabetes. This study evaluated the association between the serum hsCRP and the components of metabolic syndrome (MS) and microvascular complications in type 2 diabetes. Two hundred and sixty-nine patients with type 2 diabetes were enrolled. All the subjects underwent measurement of MS and carotid intima-media thickness (IMT). The serum hsCRP concentrations and the 24 h urine albumin excretion amounts were measured. Ophthalmoscope examinations and nerve conduction velocity tests were performed to evaluate microvascular complications. The hsCRP was significantly higher in the patients with MS than in those without (p = 0.019). The serum hsCRP was significantly correlated with all the components of MS. There were no differences between the serum hsCRP levels of those with and without retinopathy and neuropathy. The serum hsCRP was correlated with the 24 h urine albumin excretion amount. Serum hsCRP level has a significant correlation with MS and might be used as the future criteria of MS. Among microvascular complications, only diabetic nephropathy is associated with the serum hsCRP level. It suggests that the inflammatory process plays a role in nephropathy 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.

Section snippets

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.

References (47)

  • P.M. Ridker

    Clinical application of C-reactive protein for cardiovascular disease detection and prevention

    Circulation

    (2003)
  • N.S. Rost et al.

    Plasma concentration of C-reactive protein and risk of ischemic stroke and transient ischemic attack: the Framingham study

    Stroke

    (2001)
  • P.M. Ridker et al.

    Comparison of C-reactive protein and low-density lipoprotein cholesterol in the prediction of first cardiovascular events

    N. Engl. J. Med.

    (2002)
  • P.M. Ridker et al.

    Novel risk factors for systemic atherosclerosis: a comparison of C-reactive protein, fibrinogen, homocysteine, lipoprotein(a), and standard cholesterol screening as predictors of peripheral arterial disease

    JAMA

    (2001)
  • A.D. Pradhan et al.

    C-reactive protein, interleukin 6, and the risk of developing type 2 diabetes mellitus

    JAMA

    (2001)
  • D.J. Freeman et al.

    C-reactive protein is an independent predictor of risk for the development of diabetes in the west of Scotland: coronary prevention study

    Diabetes

    (2002)
  • D. Aronson et al.

    Obesity is the major determinant of elevated C-reactive protein in subjects with the metabolic syndrome

    Int. J. Obes. Relat. Metab. Disord.

    (2004)
  • T.S. Han et al.

    Prospective study of C-reactive protein in relation to the development of diabetes and metabolic syndrome in the Mexico city: diabetes study

    Diab. Care

    (2002)
  • K. Tamakoshi et al.

    The metabolic syndrome is associated with elevated circulating C-reactive protein in healthy reference range, a systemic low-grade inflammatory state

    Int. J. Obes. Relat. Metab. Disord.

    (2003)
  • P.M. Ridker et al.

    C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14719 initially healthy American women

    Circulation

    (2003)
  • DRS report no. 3. Four risk factors for severe visual loss in diabetic retinopathy

    Arch. Ophthalmol.

    (1979)
  • S. Rosfors et al.

    Relationship between intima-media thickness in the common carotid artery and atherosclerosis in the carotid bifurcation

    Stroke

    (1998)
  • P. Giral et al.

    Risk factors and early extracoronary atherosclerosis plaques detected by three site ultrasound imaging in hypercholesterolemic men

    Arch. Intern. Med.

    (1991)
  • Cited by (67)

    • Association of serum high-sensitivity C-reactive protein with metabolic control and diabetic chronic vascular complications in patients with type 2 diabetes

      2017, Diabetes and Metabolic Syndrome: Clinical Research and Reviews
      Citation Excerpt :

      Several studies have shown that patients with MetS have a higher hs-CRP level than those without MetS [8–14]. Several studies have conclusively identified associations between levels of hs-CRP and DCVCCxs, as well as atherosclerosis risk [15–20]. However, not enough evidence currently exists that would allow us to conclude that levels of hs-CRP can be used as a predictor for DCVCCxs.

    View all citing articles on Scopus
    View full text