High-Sensitivity C-Reactive Protein Is Associated With Incident Type 2 Diabetes Among African Americans: The Jackson Heart Study

Abstract

OBJECTIVEPrevious studies on the association between hs-CRP and incident type 2 diabetes among African Americans have been inconclusive. We examined the association between hs-CRP and incident diabetes in a large African American cohort (Jackson Heart Study).RESEARCH DESIGN AND METHODShs-CRP was measured in 3,340 participants. Incident diabetes was defined by fasting glucose ≥126 mg/dL, physician diagnosis, use of diabetes drugs, or A1C ≥6.5% (48 mmol/mol) at follow-up. Cox regression was used to estimate hazard ratios (HRs) for incident diabetes, adjusting for age, sex, education, diabetes family history, alcohol, HDL, triglycerides, hypertension status, hypertension medications, physical activity, BMI, HOMA-insulin resistance (HOMAIR), and waist circumference.RESULTSParticipants (63% women) were aged 53.3 ± 12.5 years. During a median follow-up of 7.5 years, 17.4% developed diabetes (23.1/1,000 person-years, 95% CI 21.3–25.1). After adjustment, the HR (hs-CRP third vs. first tertile) was 1.64 (95% CI 1.26–2.13). In separate models, further adjustment for BMI and waist circumference attenuated this association (HR 1.28 [95% CI 0.97–1.69] and 1.35 [95% CI 1.03–1.78, P < 0.05 for trend], respectively). Upon adding HOMAIR in the models, the association was no longer significant. In adjusted HOMAIR-stratified analysis, the hs-CRP–diabetes association appeared stronger in participants with HOMAIR <3.0 compared with HOMAIR ≥3.0 (P < 0.0001 for interaction). The association was also stronger among nonobese participants, although not significant when adjusted for HOMAIR.CONCLUSIONSLow-grade inflammation, as measured by hs-CRP level, may have an important role in the development of diabetes among African Americans with a lesser degree of insulin resistance.

High‐Intensity Cigarette Smoking Is Associated With Incident Diabetes Mellitus In Black Adults: The Jackson Heart Study

“…Previous studies, including analyses from the JHS, have observed a positive relationship between hs‐CRP (biomarker of inflammation) and incident diabetes mellitus 13, 29. However, this association was largely explained by measures of obesity including BMI and WC.…”

“…It has been hypothesized that smoking‐induced inflammation or obesity may contribute to diabetes mellitus onset 11, 12, 13. Although smoking has been associated with reduced body mass index (BMI), smoking is positively associated with visceral adiposity, a known risk factor for diabetes mellitus 14.…”

Independent associations between a metabolic syndrome severity score and future diabetes by sex and race: the Atherosclerosis Risk In Communities Study and Jackson Heart Study

“…In ARIC, participants were defined as having type 2 diabetes if they reported that a physician had told them they had diabetes, if they had a fasting serum glucose ≥6.99 mmol/l (126 mg/dl) or a non-fasting serum glucose ≥11.10 mmol/l (200 mg/dl), or if they reported that they were taking insulin or oral hypoglycaemic medications [20, 21]. In the JHS, participants were defined as having diabetes if they had a fasting serum glucose ≥6.99 mmol/l (126 mg/dl) or an HbA 1c ≥6.5% (48 mmol/mol) or if they had taken a diabetic medication within the 2 weeks before the clinic visit.…”

Diabetes mellitus related biomarker: The predictive role of growth-differentiation factor-15

“…The most commonly used inflammatory biomarker in established diabetes is highly selective Creactive protein (hs-CRP), which well correlates with CV complications, poorer metabolic control and severe hypoglycaemia in diabetes, although low sensitivity and specificity of this biomarker was found [11][12][13][14]. Apart from serial testing of hs-CRP, which is time-consuming, other novel pro-inflammatory biomarkers like Growth-Differentiation Factor-15 (GDF-15) have been proposed risk stratify patients with diabetes including type two diabetes mellitus (T2DM) [15].…”