Predictive value of high sensitivity C-reactive protein in three-vessel disease patients with and without type 2 diabetes

Abstract

Background Diabetes mellitus (DM) and atherosclerosis are multifactorial conditions and share a common inflammatory basis. Three-vessel disease (TVD) represents a major challenge for coronary intervention. Nonetheless, the predictive value of high-sensitivity C-reactive protein (hs-CRP) for TVD patients with or without type 2 DM remains unknown. Herein, we aimed to ascertain the long-term predictive value of hs-CRP in TVD patients according to type 2 DM status from a large cohort. Methods A total of 2734 TVD patients with (n = 1040, 38%) and without (n = 1694, 62%) type 2 diabetes were stratified based on the hs-CRP (< 2 mg/L vs. ≥ 2 mg/L). Three multivariable analysis models were performed to evaluate the effect of potential confounders on the relationship between hs-CRP level and clinical outcomes. The Concordance index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were calculated to assess the added effect of hs-CRP and the baseline model with established risk factors on the discrimination of clinical outcomes. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE). Results The median follow-up duration was 2.4 years. Multivariate Cox regression analyses showed that the incidence of MACCE (adjusted hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.01–1.35, p = 0.031) and all-cause death (HR 1.82, 95% CI 1.07–3.11, p = 0.026) were significantly higher in the diabetic group compared to the non-diabetic group. In the diabetic group, the incidence of MACCE (adjusted HR 1.51, 95% CI 1.09–2.10, p = 0.013) was significantly higher in the high hs-CRP group than in the low hs-CRP group; no significant difference was found for all-cause death (HR 1.63; 95% CI 0.58–4.58, p = 0.349). In the non-diabetic group, the prevalence of MACCE (adjusted HR 0.93, 95% CI 0.71–1.22, p = 0.613) was comparable between the two groups. Finally, the NRI (0.2074, p = 0.001) and IDI (0.0086, p = 0.003) for MACCE were also significantly increased after hs-CRP was added to the baseline model in the diabetic group. Conclusions Elevated hs-CRP is an independent prognostic factor for long-term outcomes of MACCE in TVD patients with type 2 diabetes but not in those without type 2 diabetes. Compared to traditional risk factors, hs-CRP improved the risk prediction of adverse cardiovascular events in TVD patients with type 2 diabetes.

Microbiota based personalized nutrition improves hyperglycaemia and hypertension parameters and reduces inflammation: a prospective, open label, controlled, randomized, comparative, proof of concept study

“…Chronic inflammation has been found to be associated with type 2 diabetes, hyperlipidaemia etc ., ( Han & Lin, 2014 ; Guo et al, 2023 ). High CRP level is an indicator of inflammation and underlying disease conditions such as cardiovascular diseases and type 2 diabetes ( Bafei et al, 2023 ; Kuppa et al, 2023 ; Guo et al, 2023 ).…”

Microbiota based personalized nutrition improves hyperglycaemia and hypertension parameters and reduces inflammation: A prospective, open label, controlled, randomized, comparative, proof of concept study

“…48,49 . High CRP level is an indicator of inflammation and underlying disease conditions such as cardiovascular diseases and type 2 diabetes [50][51][52] . We evaluated the change in CRP level in a subset of participants whose basal serum CRP level was >=2mg/L prior to intervention [9 out of 15 participants].…”

“…This might be one of the reasons for reduced inflammation as increased Prevotella has been found to have proinflammatory effect 53 . Similarly increased Levilactobacillus brevis and Roseburia have been associated with reduced inflammation 54,55,56,[50][51][52] . Lowered CRP levels after dietary intervention further shows the positive impact of the microbiome-based personalized nutrition in chronic disease conditions such as Type 2 Diabetes.…”

Prognostic Value of Fibrinogen-to-Albumin Ratio in Coronary Three-Vessel Disease

“… 3 In addition, the risk of mortality in patients with three-vessel disease is almost twice as high as in patients with single-vessel disease and is an independent predictor of adverse clinical outcomes compared to single-vessel disease. 4 …”

“…3 In addition, the risk of mortality in patients with three-vessel disease is almost twice as high as in patients with single-vessel disease and is an independent predictor of adverse clinical outcomes compared to single-vessel disease. 4 Fibrinogen, a plasma protein produced by the liver, is an indicator of thrombotic status and plays a role in inflammatory processes of varying degrees of severity. 5 Baseline plasma fibrinogen levels are predictive of cardiovascular events in patients with CAD.…”