Cardiovascular disease in U.S. patients with metabolic syndrome, diabetes, and elevated C-reactive protein
Shaista Malik1, Nathan D Wong, Stanley Franklin
1Heart Disease Prevention Program, Division of Cardiology, Department of Medicine, C240 Medical Sciences, University of California, Irvine, CA 92697, USA.
Insights
Elevated C-reactive protein (CRP) significantly increases cardiovascular disease (CVD) risk in individuals with metabolic syndrome and diabetes. CRP levels help stratify CVD risk in these patient groups.
Area of Science:
- Cardiology
- Clinical Chemistry
- Epidemiology
Background:
- C-reactive protein (CRP) is a known independent predictor of cardiovascular disease (CVD).
- The role of CRP in stratifying CVD risk specifically within populations diagnosed with metabolic syndrome and diabetes remains less understood.
- This study investigates the interplay between metabolic syndrome, diabetes, CRP levels, and CVD risk in U.S. adults.
Purpose of the Study:
- To evaluate whether elevated C-reactive protein (CRP) levels modify the association between metabolic syndrome and diabetes with cardiovascular disease (CVD).
- To determine if CRP can be used to stratify CVD risk in individuals with metabolic syndrome and diabetes.
Main Methods:
- A cross-sectional analysis of 3,873 U.S. adults from the National Health and Nutrition Examination Survey (1999-2000) was conducted.
- Participants were categorized based on the presence of metabolic syndrome, diabetes, and C-reactive protein (CRP) levels (low, intermediate, high).
- Logistic regression analysis was employed to assess the odds of CVD across different disease and CRP strata, adjusting for relevant covariates.
Main Results:
- Compared to individuals without metabolic syndrome or diabetes and with low CRP, those with no disease but high CRP had nearly double the odds of CVD (OR 1.99).
- Individuals with metabolic syndrome and intermediate CRP showed 2.67 times the odds of CVD, while those with metabolic syndrome and high CRP had 3.33 times the odds.
- The highest odds of CVD were observed in individuals with diabetes and intermediate (OR 6.01) or high CRP levels (OR 7.73).
Conclusions:
- Elevated C-reactive protein (CRP) is associated with a higher prevalence of cardiovascular disease (CVD) in individuals with metabolic syndrome or diabetes.
- Stratifying patients with metabolic syndrome or diabetes by their CRP levels may provide additional valuable prognostic information for CVD risk assessment.
Objective:
C-reactive protein (CRP) independently predicts cardiovascular disease (CVD); whether it can stratify risk in those with metabolic syndrome and diabetes is not well documented. We evaluated whether elevated CRP levels modify the relationship of metabolic syndrome and diabetes with CVD in U.S. adults.
Research Design And Methods:
In a cross-sectional study of 3,873 subjects (weighted to 156 million) aged >/=18 years participating in the National Health and Nutrition Examination Survey 1999-2000, subjects were classified as having diabetes, metabolic syndrome according to modified National Cholesterol Education Program criteria, or neither condition by low (<1 mg/l), intermediate (1-3 mg/l), or high (>3 mg/l) CRP levels. Logistic regression examined the odds of CVD by disease condition and CRP group.
Results:
After adjusting for age, sex, smoking, and total cholesterol, compared with those with neither metabolic syndrome nor diabetes and low CRP levels, the odds of CVD were 1.99 (95% CI 1.10-3.59) for those with no disease and high CRP levels and 2.67 (1.30-5.48) for those with metabolic syndrome and intermediate CRP. Persons with metabolic syndrome but high CRP had an odds ratio (OR) of 3.33 (1.80-6.16), similar to those with diabetes and low CRP (3.21 [1.27-8.09]). The likelihood of CVD was highest in those with diabetes who had intermediate CRP levels (6.01 [2.54-14.20]) and in those with diabetes and high CRP (7.73 [3.99-14.95]).
Conclusions:
In this cross-sectional analysis, CVD is more common in those with metabolic syndrome or diabetes who have elevated CRP. Stratification by CRP may add prognostic information in patients with metabolic syndrome or diabetes.
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