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Background  The prognostic value of C‐reactive protein ( CRP ) is controversial in type 2 diabetes mellitus. We aimed to assess it in a cohort of high cardiovascular risk diabetic patients.    Methods and Results   CRP  was measured at baseline and during the second year of follow‐up in 616 patients. The primary end points were a composite of total fatal and nonfatal cardiovascular events ( CVE s), major  CVE s, and all‐cause and cardiovascular mortalities. Association between baseline and second‐year  CRP  with end points were evaluated by multivariable Cox survival analyses. Baseline median  CRP  was 2.8 mg/L (interquartile range: 1.2–6.0 mg/L), and 47.8% of the patients either increased or persisted with high  CRP  levels during the first 2 years of follow‐up. After a median follow‐up of 8.4 years, 131 total  CVE s occurred (89 major  CVE s), and 129 patients died (53 of cardiovascular causes). Baseline and second‐year  CRP , analyzed as a continuous variable and dichotomized at >3.0 mg/L, were significantly associated with total and major  CVE s occurrence (with adjusted hazard ratios between 1.22 and 1.34 for increments of 1‐ SD  log of continuous  CRP , and between 1.47 and 1.89 for dichotomized  CRP ), but not with mortality. Additionally, increasing  CRP  levels or persisting with high levels were associated with a 1.84 (95%  CI : 1.10–3.06) excess risk of major  CVE s, independent of baseline  CRP  values.    Conclusions  Baseline and serial changes in  CRP  levels provide cardiovascular risk prediction independent of standard risk factors and glycemic control, and may be useful to refine cardiovascular risk stratification in high‐risk patients with type 2 diabetes mellitus.

journal of the american heart association

Prognostic Importance of C‐Reactive Protein in High Cardiovascular Risk Patients With Type 2 Diabetes Mellitus: The Rio de Janeiro Type 2 Diabetes Cohort Study