High sensitivity C reactive protein (hs CRP) and low-density lipoprotein cholesterol (LDL-C) levels may accurately predict risk for recurrent major adverse cardiovascular events (MACE) in patients with type 2 diabetes and a history of recent acute coronary syndrome, according to an analysis published in Diabetes, Obesity and Metabolism.
Investigators sought to determine the predictive value of baseline hsCRP for MACE in patients with type 2 diabetes and recent acute coronary syndrome who were at high risk for cardiovascular disease (n=5380). Patient data were obtained from the EXAMINE trial (ClinicalTrials.gov Identifier: NCT00968708).
Study participants were stratified according to serum levels of hsCRP at baseline (<1, 1-3, and >3 mg/L). Patients were then categorized into 4 groups according to achieved LDL-C levels (<70 or ≥70 mg/dL) and baseline hsCRP (≤3 or >3 mg/L).
At 30 months, patients with levels of hsCRP <1, 1-3, and >3 mg/L had cumulative MACE incidences of 11.5%, 14.6%, and 18.4%, respectively. Compared with participants with hsCRP levels <1 mg/L, those with levels of hsCRP >3 mg/L were deemed to have an adjusted hazard ratio of 1.42 for MACE and 1.77 for mortality from any cause.
The cumulative incidence for MACE was 11.0% among participants with low LDL-C and low hsCRP. Patients with low LDL-C and high hsCRP as well as those with high LDL-C and low hsCRP featured MACE cumulative incidences of 14.4% and 15.6%, respectively (P <.001).
According to the investigators, a limitation of this analysis was the availability of only one hsCRP measurement at baseline. Therefore, excluding the potential for hsCRP level variability caused by an acute-phase reaction was deemed impossible. In addition, the study investigators were unable to account for dietary, lifestyle, and family history risk factors, all of which may influence the risk for future heart disease.
Despite these limitations, the investigators believe hsCRP and LDL-C levels represent “2 simple and widely available tests [that] could help to risk stratify this group of patients” for appropriate therapy.
Hwang YC, Morrow DA, Cannon CP, et al. High-sensitivity C-reactive protein, low-density lipoprotein cholesterol, and cardiovascular outcomes in patients with type 2 diabetes in the EXAMINE (Examination of Cardiovascular Outcomes With Alogliptin Versus Standard of Care) trial [published online October 24, 2017] Diabetes Obes Metab. doi: 10.1111/dom.13136