Serum high-sensitivity C-reactive protein level predicts cardiovascular events in Chinese patients with type 2 diabetes with no known cardiovascular disease

Abstract

Background The association between serum high-sensitivity C-reactive protein (hsCRP) and cardiovascular disease (CVD) in type 2 diabetes (T2DM) remains controversial. Previous studies, performed mostly in Western populations, demonstrated its prognostic importance only in T2DM subjects with known CVD but not in those without. Here, we investigated prospectively whether serum hsCRP could predict incident cardiovascular outcomes in Chinese subjects with T2DM with no known CVD. Method Baseline serum hsCRP levels were measured in 5,746 Chinese subjects with T2DM recruited from the Hong Kong West Diabetes Registry. The role of serum hsCRP in predicting incident CVD was analyzed using Cox regression analysis. Results Amongst 3,742 subjects with no known CVD, 295 (7.9%) developed incident CVD over a median follow-up of 3.8 years. On multivariable Cox regression analysis, baseline serum hsCRP levels independently predicted incident CVD (Hazard ratio [HR] 1.11; 95% confidence interval [CI] 1.01 – 1.22; p = 0.024). Serum hsCRP ≥3mg/L, derived either by hsCRP quartiles or from cut-points suggested by the American Heart Association, was an independent predictor of incident CVD (HR 1.50, 95%CI 1.06 – 2.13, p = 0.022 and HR 1.51, 95%CI 1.13 – 2.03, p = 0.006, respectively), and significantly improved category free net reclassification index and integrated discrimination improvement, beyond conventional cardiovascular risk factors including gender, age, smoking status, diabetes duration, HbA1c, hypertension, dyslipidemia, estimated glomerular filtration rate and albuminuria status. Conclusions Serum hsCRP, at a cut-off of ≥3mg/L, was an independent predictor of incident CVD and could be usefully employed for risk stratification in primary prevention of CVD among Chinese subjects with T2DM.