Contribution of High Sensible C-Reactive Protein (hsCRP) in the Assessment of the Risk of Onset of Type 2 Diabetes and Its Cardiovascular Complications
Background: Type 2 diabetes is a metabolic disease characterized by chronic hyperglycemia. The latter plays an essential role in inflammation by stimulating the production of pro-inflammatory cytokines or by increasing their secretion by an oxidative mechanism. These cytokines control the hepatic synthesis of an inflammatory protein called C-Reactive Protein (CRP). High or average values of CRP would have a predictive value of cardiovascular diseases and type 2 diabetes. The relationship between low CRP values and the risk of developing type 2 diabetes and its cardiovascular complications is not sufficiently studied. The hsCRP could serve as a predictive biomarker of risk of onset, follow-up and prognosis for type 2 diabetes and its cardiovascular complications. To answer this problem, we conducted this study, the aim of which was to study the predictive role of hsCRP in the risk of occurrence of type 2 diabetes and its cardiovascular complications. Materials and Methods: This is a prospective and cross-sectional case-control study involving 200 participants including 100 control women and 100 women with type 2 diabetes (mean age was respectively 49.89 years ± 8.26 & 51.92 years ± 7.18; p = 0.066). The interviews were conducted on the basis of a questionnaire. Physical examination collected biometric data and cardiovascular constants.The biochemical parameters such as hsCRP were analyzed by an automated Abbott device. Results: We noted that hsCRP was significantly higher in type 2 diabetic subjects compared to control subjects (p < 0.0001). In control women, we found a positive correlation between hsCRP and body mass index(rho = 0.40, p < 0.0001), waist-hip ratio (rho = 0.24, p < 0.0001),systolic blood pressure (rho = 0.30, p = 0.003), diastolic blood pressure (rho = 0.28, p = 0.006), total body fat (rho = 0.48, p < 0.0001), visceral fat level (rho = 0.47, p < 0.0001). At the same time, it was positively correlated with glycated hemoglobin (rho = 0.29, p = 0.003), fasting insulin (rho = 0.22, p = 0.026), HOMA-IR (rho = 0.21, p = 0.034), C-peptide level (rho = 0.35, p = 0.0003), total cholesterol (rho = 0.24, p = 0.016), HDL cholesterol (rho = 0.24, p = 0.019), apolipoprotein B (rho = 0.25, p = 0.013). At the same time, hsCRP was negatively correlated with adiponectin level (rho = -0.21, p = 0.04) and the nitric oxide level (rho = −0.26, p = 0.01). In
References
[1]
Shaw, J.E., Sicree, R.A. and Zimmet, P.Z. (2010) Global Estimates of the Prevalence of Diabetes for 2010 and 2030. Diabetes Research and Clinical Practice, 87, 4-14. https://doi.org/10.1016/j.diabres.2009.10.007
[2]
Reddy, P.H. (2017) Can Diabetes Be Controlled by Lifestyle Activities? Current Research in Diabetes & Obesity Journal, 1, Article ID: 555568.
[3]
Sebai, I., Oueslati, I., Khessairi, N., Yazidi, M., Talbi, E., Chaker, F., et al. (2019) Predictive Factors of Macroangiopathy in Type 2 Diabetic Patients. Archives of Cardiovascular Diseases Supplements, 11, e337. https://doi.org/10.1016/j.acvdsp.2019.05.015
[4]
Dajani, R., Li, J., Wei, Z., March, M.E., Xia, Q., Khader, Y., Hakooz, N., Fatahallah, R., El-Khateeb, M., Arafat, A., Saleh, T., Dajani, A.R., Al-Abbadi, Z., Qader, M.A., Shiyab, A.H., Bateiha, A., Ajlouni, K. and Hakonarson, H. (2017) Genome-Wide Association Study Identifies Novel Type II Diabetes Risk Loci in Jordan Subpopulations. PeerJ, 5, e3618. https://doi.org/10.7717/peerj.3618
[5]
Esposito, K., Nappo, F., Marfella, R., Giugliano, G., Giugliano, F., Ciotola, M., et al. (2002) Inflammatory Cytokine Concentrations Are Acutely Increased by Hyperglycemia in Humans: Role of Oxidative Stress. Circulation, 106, 2067-2072. https://doi.org/10.1161/01.CIR.0000034509.14906.AE
[6]
Pearson, T.A., Mensah, G.A., Alexander, R.W., anderson, J.L., Cannon, R.O., Criqui, M., et al. (2003) Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice: A Statement for Healthcare Professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation, 107, 499-511. https://doi.org/10.1161/01.CIR.0000052939.59093.45
[7]
Hu, F.B., Meigs, J.B., Li, T.Y., Rifai, N. and Manson, J.E. (2004) Inflammatory Markers and Risk of Developing Type 2 Diabetes in Women. Diabetes, 53, 693-700. https://doi.org/10.2337/diabetes.53.3.693
[8]
Mugabo, Y., Li, L. and Renier, G. (2010) The Connection between C-Reactive Protein (CRP) and Diabetic Vasculopathy. Focus on Preclinical Findings. Current Diabetes Reviews, 6, 27-34. https://doi.org/10.2174/157339910790442628
[9]
Yudkin, J.S., Stehouwer, C.D., Emeis, J.J. and Coppack, S.W. (1999) C-Reactive Protein in Healthy Subjects: Associations with Obesity, Insulin Resistance, and Endothelial Dysfunction: A Potential Role for Cytokines Originating from Adipose Tissue? Arteriosclerosis, Thrombosis, and Vascular Biology, 19, 972-978. https://doi.org/10.1161/01.ATV.19.4.972
[10]
Hotamisligil, G.S., Shargill, N.S. and Spiegelman, B.M. (1993) Adipose Expression of Tumor Necrosis Factor-Alpha: Direct Role in Obesity-Linked Insulin Resistance. Science, 259, 87-91. https://doi.org/10.1126/science.7678183
[11]
Mahajan, A., Tabassum, R., Chavali, S., Dwivedi, O.P., Bharadwaj, M., Tandon, N., et al. (2009) High-Sensitivity C-Reactive Protein Levels and Type 2 Diabetes in Urban North Indians. The Journal of Clinical Endocrinology & Metabolism,94, 2123-2127. https://doi.org/10.1210/jc.2008-2754
[12]
Jaiswal, A., Tabassum, R., Podder, A., Ghosh, S., Tandon, N. and Bharadwaj, D. (2012) Elevated Level of C-Reactive Protein Is Associated with Risk of Prediabetes in Indians. Atherosclerosis, 222, 495-501. https://doi.org/10.1016/j.atherosclerosis.2012.02.034
[13]
Ortolani, P., Marzochi, A., Marrozzini, C., et al. (2007) Predictive Value of High Sensitivity C-Reactive Protein in Patients with ST-Elevation Myocardial Infarction Treated with Percutaneous Coronary Intervention. European Heart Journal, 29, 1241-1249. https://doi.org/10.1093/eurheartj/ehm338
[14]
Rifai, N. and Ridker, P.M. (2001) Proposed Cardiovascular Risk Assessment Algorithm Using High-Sensitivity C-Reactive Protein and Lipid Screening. Clinical Chemistry, 47, 28-30. https://doi.org/10.1093/clinchem/47.1.28
[15]
Ridker, P.M., Rifai, N., Rose, L., Buring, J.E. and Cook, N.R. (2002) Comparison of Creactive Protein and Low-Density Lipoprotein Cholesterol Levels in the Prediction of First Cardiovascular Events. The New England Journal of Medicine, 347, 1557-1565. https://doi.org/10.1056/NEJMoa021993
[16]
Libby, P. (2013) Mechanisms of Acute Coronary Syndromes and Their Implications for Therapy. The New England Journal of Medicine, 368, 2004-2013. https://doi.org/10.1056/NEJMra1216063
[17]
Torzewski, M., Rist, C., Mortensen, R.F., Zwaka, T.P., Bienek, M., Waltenberger, J., Koenig, W., Schmitz, G., Hombach, V. and Torzewski, J. (2000) C-Reactive Protein in the Arterial Intima: Role of C-Reactive Protein Receptor-Dependent Monocyte Recruitment in Atherogenesis. Arteriosclerosis, Thrombosis, and Vascular Biology, 20, 2094-2099. https://doi.org/10.1161/01.ATV.20.9.2094
[18]
Ridker, P.M. and Cook, N. (2004) Clinical Usefulness of Very High and Very Low Levels of C-Reactive Protein across the Full Range of Framingham Risk Scores. Circulation, 109, 1955-1959. https://doi.org/10.1161/01.CIR.0000125690.80303.A8
[19]
Verma, S., Kuliszewski, M.A., Li, S.H., Szmitko, P.E., Zucco, L., Wang, C.H., Badiwala, M.V., Mickle, D.A., Weisel, R.D., Fedak, P.W., Stewart, D.J. and Kutryk, M.J. (2002) Creactive Protein Attenuates Endothelial Progenitor Cell Survival, Differentiation, and Function: Further Evidence of a Mechanistic Link between C-Reactive Protein and Cardiovascular Disease. Circulation, 109, 2058-2067. https://doi.org/10.1161/01.CIR.0000127577.63323.24
[20]
Goswami, B., Tayal, D., Tyagi, S. and Mallika, V. (2011) Assessment of Insulin Resistance, Dyslipidemia and Inflammatory Response in North Indian Male Patients with Angiographically Proven Coronary Artery Disease. Minerva Cardioangiologica, 59, 139-147.
[21]
Rajeshwar, K., Kaul, S., Al-Hazzani, A., Babu, M.S., Balakrishna, N., Sharma, V., Jyothy, A. and Munshi, A. (2012) C-Reactive Protein and Nitric Oxide Levels in Ischemic Stroke and Its Subtypes: Correlation with Clinical Outcome. Inflammation, 35, 978-984. https://doi.org/10.1007/s10753-011-9401-x
[22]
Griendling, K.K., Ushio-Fukai, M., Lassegue, B. and Alexander, R.W. (1997) Angiotensin II Signaling in Vascular Smooth Muscle. New Concepts. Hypertension, 29, 366-373. https://doi.org/10.1161/01.HYP.29.1.366
[23]
Matzinger, P. (2002) The Danger Model: A Renewed Sense of Self. Science, 296, 301-305. https://doi.org/10.1126/science.1071059
[24]
Binder, C.J., Chang, M.K., Shaw, P.X., Miller, Y.I., Hartvigsen, K., Dewan, A. and Witztum, J.L. (2002) Innate and Acquired Immunity in Atherogenesis. Nature Medicine, 8, 1218-1226. https://doi.org/10.1038/nm1102-1218
[25]
De Ferranti, S.D. and Rifai, N. (2007) C-Reactive Protein: A Nontraditional Serum Marker of Cardiovascular Risk. Cardiovascular Pathology, 16, 14-21. https://doi.org/10.1016/j.carpath.2006.04.006
[26]
Mendall, M.A., Patel, P., Ballam, L., Strachan, D. and Northfield, T.C. (1996) C Reactive Protein and Its Relation to Cardiovascular Risk Factors: A Population Based Cross Sectional Study. BMJ, 312, 1061-1065. https://doi.org/10.1136/bmj.312.7038.1061
[27]
Cook, D.G., Mendall, M.A., Whincup, P.H., Carey, I.M., Ballam, L., Morris, J.E., Miller, G.J. and Strachan, D.P. (2000) C-Reactive Protein Concentration in Children: Relationship to Adiposity and Other Cardiovascular Risk Factors. Atherosclerosis, 149,139-150. https://doi.org/10.1016/S0021-9150(99)00312-3
[28]
Ridker, P.M., Hennekens, C.H., Buring, J.E. and Rifai, N. (2000) C-Reactive Protein and Other Markers of Inflammation in the Prediction of Cardiovascular Disease in Women. The New England Journal of Medicine, 342, 836-843. https://doi.org/10.1056/NEJM200003233421202
[29]
Ridker, P.M. (2003) Clinical Application of C-Reactive Protein for Cardiovascular Disease Detection and Prevention. Circulation, 107, 363-369. https://doi.org/10.1161/01.CIR.0000053730.47739.3C
[30]
Hansson, G.K. (2005) Inflammation, Atherosclerosis, and Coronary Artery Disease. The New England Journal of Medicine, 352, 1685-1695. https://doi.org/10.1056/NEJMra043430
[31]
Elkind, M.S., Tai, W., Coates, K., Paik, M.C. and Sacco, R.L. (2006) High Sensitivity C-Reactive Protein, Lipoprotein-Associated Phospholipase A2, and Outcome after Ischemic Stroke. Archives of Internal Medicine, 166, 2073-2080. https://doi.org/10.1001/archinte.166.19.2073
[32]
Grandjean, F., Berlage, V., Auger, L., Robert, F., Vankerhoven, P. and Cirriez, J.M. (2006) High Sensitivity CRP, Two Approaches. Immuno-Analyse & Biologie Spécialisée, 21, 168-171. https://doi.org/10.1016/j.immbio.2006.04.001