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C‐reactive protein and incident diabetes in patients with arterial disease
Author(s) -
Verhagen Sandra N.,
Wassink Annemarie M. J.,
Graaf Yolanda,
Visseren Frank L. J.
Publication year - 2013
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.12142
Subject(s) - medicine , insulin resistance , diabetes mellitus , type 2 diabetes , body mass index , c reactive protein , quartile , cohort , endocrinology , blood pressure , systemic inflammation , gastroenterology , confidence interval , inflammation
Systemic low‐grade inflammation, as measured by high‐sensitive C‐reactive protein (hs CRP ), may contribute to the risk of type 2 diabetes in patients with manifest arterial disease. Methods Cohort study in 4072 patients with manifest arterial disease without diabetes. The relation between quartiles of hs CRP and type 2 diabetes was assessed with Cox regression analyses, taking age, smoking and blood pressure–lowering medication and lipid‐lowering medication into account. Insulin resistance was estimated with homeostasis model of insulin resistance ( HOMA ‐ IR ). In exploratory models, adjustments were performed for body mass index ( BMI ) and visceral and subcutaneous adipose tissue thickness. Results During a median follow‐up of 5·0 ( IQR 2·5–8·2) years, 288 subjects developed diabetes. High hs CRP was independently associated with incident diabetes (Q4 vs. Q1 males: HR 1·62; 95% CI 1·06–2·48; females: HR 3·12; 95% CI 1·57–6·21). HOMA ‐ IR at baseline is related to hs CRP plasma levels (Q4 vs. Q1: males: β 0·27; 95% CI 0·19–0·36; females: β 0·35; 95% CI 0·22–0·48). The risk of diabetes associated with hs CRP was abolished in males (Q4 vs. 1 HR 1·23; 95% CI 0·80–1·88) and attenuated in females (Q4 vs. 1 HR 2·32; 95% CI 1·14–4·75) after adding BMI to the model, but not modified by statin use ( P for interaction: 0·61). Conclusions Patients with manifest arterial disease with high hs CRP plasma levels are at increased risk to develop type 2 diabetes and are more insulin resistant as compared to those with low hs CRP levels. This increase in risk is more pronounced in females than in males and is not modified by statin use.