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Predictive value of high sensitivity C-reactive protein in three-vessel disease patients with and without type 2
Lei Guo1, Haichen Lv1, Junjie Wang1
1Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China.
Insights
High-sensitivity C-reactive protein (hs-CRP) predicts major adverse cardiac and cerebrovascular events (MACCE) in patients with three-vessel disease (TVD) and type 2 diabetes. hs-CRP improves risk prediction for these events in diabetic TVD patients.
Area of Science:
- Cardiology
- Diabetology
- Inflammation Research
Background:
- Diabetes mellitus (DM) and atherosclerosis share inflammatory pathways.
- Three-vessel disease (TVD) poses challenges for coronary intervention.
- The prognostic value of hs-CRP in TVD patients with or without type 2 DM is unclear.
Purpose of the Study:
- To evaluate the long-term predictive value of hs-CRP in TVD patients.
- To stratify TVD patients based on type 2 diabetes status and hs-CRP levels.
- To determine if hs-CRP improves risk prediction for adverse cardiovascular events.
Main Methods:
- A cohort of 2734 TVD patients were analyzed.
- Patients were stratified by type 2 diabetes status and hs-CRP levels (< 2 mg/L vs. ≥ 2 mg/L).
- Multivariable analyses, including Cox regression, NRI, and IDI, assessed hs-CRP's predictive value for major adverse cardiac and cerebrovascular events (MACCE).
Main Results:
- Diabetic TVD patients had higher MACCE and all-cause death rates.
- In diabetic patients, elevated hs-CRP was linked to increased MACCE.
- hs-CRP did not significantly predict MACCE in non-diabetic TVD patients.
- hs-CRP addition improved MACCE risk prediction in diabetic TVD patients (NRI and IDI significant).
Conclusions:
- Elevated hs-CRP is an independent predictor of MACCE in TVD patients with type 2 diabetes.
- hs-CRP enhances risk prediction for adverse cardiovascular events in diabetic TVD patients.
- hs-CRP's prognostic value differs between diabetic and non-diabetic TVD patients.
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.
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