C-reactive protein and incident cardiovascular events among men with diabetes

OBJECTIVE - Several large prospective studies have shown that baseline levels of C-reactive protein (CRP) are an independent predictor of cardiovascular events among apparently healthy individuals. However, prospective data on whether CRP predicts cardiovascular events in diabetic patients are limited so far. RESEARCH DESIGN AND METHODS - To investigate the association between plasma CRP levels and incidence of cardiovascular events among men with type 2 diabetes, we followed prospectively a cohort of 746 American men aged 46-81 years who were free of cardiovascular diseases at the time of blood collection in 1993-1994. RESULTS - During an average of 5 years of follow-up (3,986 person-years), we identified 103 incident cardiovascular events (18 myocardial infarction, 70 coronary artery bypass grafting or angioplasty, and 15 stroke), confirmed by medical records. After adjustment for age, BMI, smoking, alcohol consumption, physical activity, family history of coronary heart disease, history of high blood pressure, history of high serum cholesterol, aspirin use, and fasting status as well as for fibrinogen, creatinine, HbA(1c), and non-HDL cholesterol levels, CRP remained significantly associated with an increased risk of cardiovascular events. The relative risks for quartiles,were 1.00, 1.51, 2.52, and 2.62 (95% CI: 1.29-5.32, P for trend: 0.011). We observed no effect modifications by plasma levels of LDL cholesterol, HDL cholesterol, non-HDL cholesterol, apolipoprotein B, HbA(1c), and fibrinogen or by BMI. CONCLUSIONS - High plasma levels of CRP were associated with an increased risk of incident cardiovascular events among diabetic men, independent of currently established lifestyle risk factors, blood lipids, and glycemic control.