CRP, C-Peptide, and Risk of First-Time Cardiovascular Events and Mortality in Early Type 2 Diabetes: A Danish Cohort Study

Anne Gedebjerg; Mette Bjerre; Alisa Devedzic Kjaergaard; Jens Steen Nielsen; Jørgen Rungby; Ivan Brandslund; Michael Maeng; Henning Beck-Nielsen; Allan Vaag; Henrik Toft Sørensen; Troels Krarup Hansen; Reimar Wernich Thomsen

doi:10.2337/dc22-1353

CRP, C-Peptide, and Risk of First-Time Cardiovascular Events and Mortality in Early Type 2 Diabetes: A Danish Cohort Study

Anne Gedebjerg, Mette Bjerre, Alisa Devedzic Kjaergaard, Jens Steen Nielsen, Jørgen Rungby, Ivan Brandslund, Michael Maeng, Henning Beck-Nielsen, Allan Vaag, Henrik Toft Sørensen, Troels Krarup Hansen, Reimar Wernich Thomsen^*

^*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

Abstract

OBJECTIVE: We investigated the relationship between hs-CRP, a marker of low-grade inflammation, alone or in combination with C-peptide, a marker of hyperinsulinemia/insulin resistance, and risk for cardiovascular events (CVEs) and mortality in patients recently diagnosed with type 2 diabetes (T2D).

RESEARCH DESIGN AND METHODS: In patients with recent-onset T2D, we measured serum hs-CRP (n = 7,301) and C-peptide (n = 5,765) in the prospective Danish Centre for Strategic Research in Type 2 Diabetes cohort study. Patients with no prior CVE (n = 6,407) were followed until first myocardial infarction, stroke, coronary revascularization, or cardiovascular death, and all patients (n = 7,301) were followed for all-cause mortality. We computed adjusted hazard ratios (aHRs) by Cox regression and tested for the interaction between hs-CRP and C-peptide.

RESULTS: During follow-up (median 4.8 years), high (>3 mg/L) versus low (<1 mg/L) hs-CRP was associated with increased CVE risk (aHR 1.45 [95% CI 1.07-1.96]) and with even greater risk of all-cause mortality (2.47 [1.88-3.25]). Compared with patients with low hs-CRP (≤3 mg/L) and low C-peptide (<1,470 pmol/L), those with high levels of both biomarkers had the highest CVE (1.61 [1.10-2.34]) and all-cause mortality risk (2.36 [1.73-3.21]). Among patients with high C-peptide, risk of CVEs did not differ by low or high hs-CRP, whereas risk of all-cause mortality did.

CONCLUSIONS: The finding of high hs-CRP as a stronger prognostic biomarker of all-cause mortality than of CVEs may facilitate improved early detection and prevention of deadly diseases besides CVEs. Conversely, elevated C-peptide as a strong CVE biomarker supports the need to target hyperinsulinemia/insulin resistance in T2D CVE prevention.

Originalsprog	Engelsk
Tidsskrift	Diabetes Care
Vol/bind	46
Nummer	5
Sider (fra-til)	1037-1045
Antal sider	9
ISSN	0149-5992
DOI	https://doi.org/10.2337/dc22-1353
Status	Udgivet - maj 2023

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10.2337/dc22-1353

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Gedebjerg, A., Bjerre, M., Kjaergaard, A. D., Nielsen, J. S., Rungby, J., Brandslund, I., Maeng, M., Beck-Nielsen, H., Vaag, A., Sørensen, H. T., Hansen, T. K., & Thomsen, R. W. (2023). CRP, C-Peptide, and Risk of First-Time Cardiovascular Events and Mortality in Early Type 2 Diabetes: A Danish Cohort Study. Diabetes Care, 46(5), 1037-1045. https://doi.org/10.2337/dc22-1353

@article{080c07f4bf2447c28a3370aec8d666b7,

title = "CRP, C-Peptide, and Risk of First-Time Cardiovascular Events and Mortality in Early Type 2 Diabetes: A Danish Cohort Study",

abstract = "OBJECTIVE: We investigated the relationship between hs-CRP, a marker of low-grade inflammation, alone or in combination with C-peptide, a marker of hyperinsulinemia/insulin resistance, and risk for cardiovascular events (CVEs) and mortality in patients recently diagnosed with type 2 diabetes (T2D).RESEARCH DESIGN AND METHODS: In patients with recent-onset T2D, we measured serum hs-CRP (n = 7,301) and C-peptide (n = 5,765) in the prospective Danish Centre for Strategic Research in Type 2 Diabetes cohort study. Patients with no prior CVE (n = 6,407) were followed until first myocardial infarction, stroke, coronary revascularization, or cardiovascular death, and all patients (n = 7,301) were followed for all-cause mortality. We computed adjusted hazard ratios (aHRs) by Cox regression and tested for the interaction between hs-CRP and C-peptide.RESULTS: During follow-up (median 4.8 years), high (>3 mg/L) versus low (<1 mg/L) hs-CRP was associated with increased CVE risk (aHR 1.45 [95% CI 1.07-1.96]) and with even greater risk of all-cause mortality (2.47 [1.88-3.25]). Compared with patients with low hs-CRP (≤3 mg/L) and low C-peptide (<1,470 pmol/L), those with high levels of both biomarkers had the highest CVE (1.61 [1.10-2.34]) and all-cause mortality risk (2.36 [1.73-3.21]). Among patients with high C-peptide, risk of CVEs did not differ by low or high hs-CRP, whereas risk of all-cause mortality did.CONCLUSIONS: The finding of high hs-CRP as a stronger prognostic biomarker of all-cause mortality than of CVEs may facilitate improved early detection and prevention of deadly diseases besides CVEs. Conversely, elevated C-peptide as a strong CVE biomarker supports the need to target hyperinsulinemia/insulin resistance in T2D CVE prevention.",

keywords = "Biomarkers, C-Peptide, C-Reactive Protein/analysis, Cardiovascular Diseases, Cohort Studies, Denmark/epidemiology, Diabetes Mellitus, Type 2/complications, Humans, Insulin Resistance, Myocardial Infarction/diagnosis, Prospective Studies, Risk Factors",

author = "Anne Gedebjerg and Mette Bjerre and Kjaergaard, {Alisa Devedzic} and Nielsen, {Jens Steen} and J{\o}rgen Rungby and Ivan Brandslund and Michael Maeng and Henning Beck-Nielsen and Allan Vaag and S{\o}rensen, {Henrik Toft} and Hansen, {Troels Krarup} and Thomsen, {Reimar Wernich}",

year = "2023",

month = may,

doi = "10.2337/dc22-1353",

language = "English",

volume = "46",

pages = "1037--1045",

journal = "Diabetes Care",

issn = "0149-5992",

publisher = "American Diabetes Association",

number = "5",

}

CRP, C-Peptide, and Risk of First-Time Cardiovascular Events and Mortality in Early Type 2 Diabetes: A Danish Cohort Study. / Gedebjerg, Anne; Bjerre, Mette ; Kjaergaard, Alisa Devedzic et al.
I: Diabetes Care, Bind 46, Nr. 5, 05.2023, s. 1037-1045.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - CRP, C-Peptide, and Risk of First-Time Cardiovascular Events and Mortality in Early Type 2 Diabetes

T2 - A Danish Cohort Study

AU - Gedebjerg, Anne

AU - Bjerre, Mette

AU - Kjaergaard, Alisa Devedzic

AU - Nielsen, Jens Steen

AU - Rungby, Jørgen

AU - Brandslund, Ivan

AU - Maeng, Michael

AU - Beck-Nielsen, Henning

AU - Vaag, Allan

AU - Sørensen, Henrik Toft

AU - Hansen, Troels Krarup

AU - Thomsen, Reimar Wernich

PY - 2023/5

Y1 - 2023/5

N2 - OBJECTIVE: We investigated the relationship between hs-CRP, a marker of low-grade inflammation, alone or in combination with C-peptide, a marker of hyperinsulinemia/insulin resistance, and risk for cardiovascular events (CVEs) and mortality in patients recently diagnosed with type 2 diabetes (T2D).RESEARCH DESIGN AND METHODS: In patients with recent-onset T2D, we measured serum hs-CRP (n = 7,301) and C-peptide (n = 5,765) in the prospective Danish Centre for Strategic Research in Type 2 Diabetes cohort study. Patients with no prior CVE (n = 6,407) were followed until first myocardial infarction, stroke, coronary revascularization, or cardiovascular death, and all patients (n = 7,301) were followed for all-cause mortality. We computed adjusted hazard ratios (aHRs) by Cox regression and tested for the interaction between hs-CRP and C-peptide.RESULTS: During follow-up (median 4.8 years), high (>3 mg/L) versus low (<1 mg/L) hs-CRP was associated with increased CVE risk (aHR 1.45 [95% CI 1.07-1.96]) and with even greater risk of all-cause mortality (2.47 [1.88-3.25]). Compared with patients with low hs-CRP (≤3 mg/L) and low C-peptide (<1,470 pmol/L), those with high levels of both biomarkers had the highest CVE (1.61 [1.10-2.34]) and all-cause mortality risk (2.36 [1.73-3.21]). Among patients with high C-peptide, risk of CVEs did not differ by low or high hs-CRP, whereas risk of all-cause mortality did.CONCLUSIONS: The finding of high hs-CRP as a stronger prognostic biomarker of all-cause mortality than of CVEs may facilitate improved early detection and prevention of deadly diseases besides CVEs. Conversely, elevated C-peptide as a strong CVE biomarker supports the need to target hyperinsulinemia/insulin resistance in T2D CVE prevention.

AB - OBJECTIVE: We investigated the relationship between hs-CRP, a marker of low-grade inflammation, alone or in combination with C-peptide, a marker of hyperinsulinemia/insulin resistance, and risk for cardiovascular events (CVEs) and mortality in patients recently diagnosed with type 2 diabetes (T2D).RESEARCH DESIGN AND METHODS: In patients with recent-onset T2D, we measured serum hs-CRP (n = 7,301) and C-peptide (n = 5,765) in the prospective Danish Centre for Strategic Research in Type 2 Diabetes cohort study. Patients with no prior CVE (n = 6,407) were followed until first myocardial infarction, stroke, coronary revascularization, or cardiovascular death, and all patients (n = 7,301) were followed for all-cause mortality. We computed adjusted hazard ratios (aHRs) by Cox regression and tested for the interaction between hs-CRP and C-peptide.RESULTS: During follow-up (median 4.8 years), high (>3 mg/L) versus low (<1 mg/L) hs-CRP was associated with increased CVE risk (aHR 1.45 [95% CI 1.07-1.96]) and with even greater risk of all-cause mortality (2.47 [1.88-3.25]). Compared with patients with low hs-CRP (≤3 mg/L) and low C-peptide (<1,470 pmol/L), those with high levels of both biomarkers had the highest CVE (1.61 [1.10-2.34]) and all-cause mortality risk (2.36 [1.73-3.21]). Among patients with high C-peptide, risk of CVEs did not differ by low or high hs-CRP, whereas risk of all-cause mortality did.CONCLUSIONS: The finding of high hs-CRP as a stronger prognostic biomarker of all-cause mortality than of CVEs may facilitate improved early detection and prevention of deadly diseases besides CVEs. Conversely, elevated C-peptide as a strong CVE biomarker supports the need to target hyperinsulinemia/insulin resistance in T2D CVE prevention.

KW - Biomarkers

KW - C-Peptide

KW - C-Reactive Protein/analysis

KW - Cardiovascular Diseases

KW - Cohort Studies

KW - Denmark/epidemiology

KW - Diabetes Mellitus, Type 2/complications

KW - Humans

KW - Insulin Resistance

KW - Myocardial Infarction/diagnosis

KW - Prospective Studies

KW - Risk Factors

UR - http://www.scopus.com/inward/record.url?scp=85159419602&partnerID=8YFLogxK

U2 - 10.2337/dc22-1353

DO - 10.2337/dc22-1353

M3 - Journal article

C2 - 36930691

SN - 0149-5992

VL - 46

SP - 1037

EP - 1045

JO - Diabetes Care

JF - Diabetes Care

IS - 5

ER -

CRP, C-Peptide, and Risk of First-Time Cardiovascular Events and Mortality in Early Type 2 Diabetes: A Danish Cohort Study

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