In vitro, C-reactive protein (CRP) impairs endothelial progenitor cell (EPC) function; however, the influence of CRP on EPCs in vivo is unclear. We determined whether EPC function is impaired in adults with elevated plasma CRP concentrations, independent of other risk factors. EPCs were harvested from 75 adults (43 males, 32 females): 25 with low CRP (< 1.0 mg/L); 25 with moderate CRP (1.0–3.0 mg/L); and 25 with high CRP (> 3.0 mg/L). The capacity of EPCs to form colonies (colony assay), migrate (Boyden chamber), release angiogenic growth factor (ELISA) and resist apoptosis (active caspase-3) was determined. There were no significant differences between the CRP groups in EPC colony formation (CFU), migration (AU) or the ability to release vascular endothelial growth factor (VEGF; pg/mL): low (13±3 CFU; 1255±100 AU; 126±24 pg/mL); moderate (11±3 CFU; 1137±85 AU; 97±14 pg/mL); and high (13±4 CFU; 1071±80 AU; 119±22 pg/mL) CRP. Staurosporine-stimulated activation of caspase-3 was also similar between the low (2.3±0.2 ng/mL), moderate (2.1±0.3 ng/mL), and high (2.2±0.2 ng/mL) CRP groups. These results indicate that elevations in plasma CRP are not associated with impaired EPC function. EPC dysfunction may not play a role in CRP-related cardiovascular risk.
In vitro, C‐reactive protein (CRP) impairs endothelial progenitor cell (EPC) function; however, the influence of CRP on EPCs in vivo is unclear. We determined whether EPC function is impaired in adults with elevated plasma CRP concentrations, independent of other risk factors. EPCs were harvested from 75 adults (43 males, 32 females): 25 with low CRP (< 1.0 mg/L); 25 with moderate CRP (1.0–3.0 mg/L); and 25 with high CRP (> 3.0 mg/L). The capacity of EPCs to form colonies (colony assay), migrate (Boyden chamber), release angiogenic growth factor (ELISA) and resist apoptosis (active caspase‐3) was determined. There were no significant differences between the CRP groups in EPC colony formation (CFU), migration (AU) or the ability to release vascular endothelial growth factor (VEGF; pg/mL): low (13±3 CFU; 1255±100 AU; 126±24 pg/mL, respectively); moderate (11±3; 1137±85; 97±14); and high (13±4; 1071±80; 119±22) CRP. Staurosporine‐stimulated activation of caspase‐3 was also similar between the low (2.3±0.2 ng/mL), moderate (2.1±0.3 ng/mL), and high (2.2±0.2 ng/mL) CRP groups. These results indicate that elevations in plasma CRP are not associated with impaired EPC function. The negative in vitro effects of CRP on EPCs may be due to the contamination of commercially available CRP preparations with lipopolysaccharide and/or azide preservatives or the use of supraphysiological CRP concentrations.
IntroductionPatients with diabetes are at greater risk of hospital readmission than patients without diabetes. There is a need to identify more modifiable risk factors for readmission as potential targets for intervention. Cardiorespiratory fitness is a predictor of morbidity and mortality. The purpose of this study was to examine whether there is an association between exercise capacity based on the maximal workload achieved during treadmill stress testing and readmission among patients with diabetes.Research design and methodsThis retrospective cohort study included adult patients with diabetes discharged from an academic medical center between July 1, 2012 and December 31, 2018 who had a stress test documented before the index discharge. Univariate analysis and multinomial multivariable logistic regressions were used to evaluate associations with readmission within 30 days, 6 months, and 1 year of discharge. Exercise capacity was measured as metabolic equivalents (METs).ResultsA total of 580 patients with 1598 hospitalizations were analyzed. Mean METs of readmitted patients were significantly lower than for non-readmitted patients (5.7 (2.6) vs 6.7 (2.6), p<0.001). After adjustment for confounders, a low METs level (<5) was associated with higher odds of readmission within 30 days (OR 5.46 (2.22–13.45), p<0.001), 6 months (OR 2.78 (1.36–5.65), p=0.005), and 1 year (OR 2.16 (1.12–4.16), p=0.022) compared with medium (5–7) and high (>7) METs level. During the 6.5-year study period, patients with low METs had a mean of 3.2±3.6 hospitalizations, while those with high METs had 2.5±2.4 hospitalizations (p=0.007).ConclusionsLower exercise capacity is associated with a higher risk of readmission within 30 days, 6 months, and 1 year, as well as a greater incidence of hospitalization, in patients with diabetes. Future studies are needed to explore whether exercise reduces readmission risk in this population.
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