High‐sensitivity C‐reactive protein, low‐density lipoprotein cholesterol and cardiovascular outcomes in patients with type 2 diabetes in the EXAMINE (Examination of Cardiovascular Outcomes with Alogliptin versus Standard of Care) trial

Abstract

AimsWe sought to assess the risk of major adverse cardiovascular events (MACE) by utilizing high‐sensitivity C‐reactive protein (hsCRP) level and low‐density lipoprotein cholesterol (LDL‐C) in patients with type 2 diabetes and recent acute coronary syndrome.Materials and methodsStudy participants enrolled in the EXAMINE trial (Clinical trials registration number: NCT00968708) and were stratified by baseline hsCRP levels (<1, 1‐3 and >3 mg/L). They were also sub‐divided into 4 groups according to baseline hsCRP (≤3 or >3 mg/L) and achieved LDL‐C (<70 or ≥70 mg/dL) levels. Among 5380 patients, the MACE rate, a composite of cardiovascular death, non‐fatal acute myocardial infarction and non‐fatal stroke, was evaluated during the 30 months of follow‐up.ResultsCumulative incidence of MACE was 11.5% (119 events), 14.6% (209 events) and 18.4% (287 events) in patients with hsCRP levels of <1, 1 to 3 and >3 mg/L, respectively (P < .001). In patients with hsCRP >3 mg/L, the adjusted hazard ratio (95% confidence interval) was 1.42 (1.13, 1.78; P = .002) for MACE compared with patients with hsCRP <1 mg/L. MACE cumulative incidences were 11.0% (128 events), 14.4% (100 events), 15.6% (194 events) and 21.3% (182 events) in patients with low LDL‐C and low hsCRP, low LDL‐C and high hsCRP, high LDL‐C and low hsCRP, and high LDL‐C and high hsCRP levels, respectively (P < .001).ConclusionsLevels of hsCRP were associated with recurrent cardiovascular events in patients with type 2 diabetes and recent acute coronary syndrome, and this association appears to be independent of and additive to the achieved LDL‐C level.

The predictive study of the relation between elevated low-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and mortality in peritoneal dialysis

“…Furthermore, we found that higher LDL-C/HDL-C ratio was related to higher CV mortality risk in diabetic patients with high level of hsCRP, but not in those with low level of hsCRP (Supplementary Table 3. ), which is similar to previous study that high level of hsCRP was associated with the risk of cardiovascular events in patients with type 2 diabetes, and the risk would be 2-fold higher when both hsCRP and LDL-C were elevated [35]. These results implied incorporating both hsCRP and lipid parameters could provide additional stratification of cardiovascular risk in patients with diabetes.…”

Cholesterol levels and development of cardiovascular disease in Koreans with type 2 diabetes mellitus and without pre-existing cardiovascular disease

“…Our study was limited in that time-varying Cox regression was not performed. Fifth, we were unable to obtain clinical information on hemoglobin A1c levels, high sensitivity C-reactive protein [40], and other medications that an affect the development of CVD. Lastly, because only the Korean population was included, our findings cannot be extrapolated to people with different ethnicities.…”

Metabolic profile and prolactin serum levels in men with type 2 diabetes mellitus: Old-new rubric

“…Physiological high PRL in diabetic rat leads to an augmentation of insulin sensitivity, reduced inflammatory cytokine expression in visceral fat, prevent adipocyte hypertrophy, and increase expression of GLUT4. [29]…”