Sensitivity and specificity of CRP as a parameter of atherosclerosis in patients with type II diabetes mellitus
Background: Type 2 diabetes mellitus (T2DM) is an inflammatory atherosclerotic condition with high prevalence of cardiovascular disease. Elevated C-reactive protein (CRP) predicts cardiovascular events in T2DM patients.
Objectives: Our work aimed to assess sensitivity and specificity of CRP in diagnosis and follow up of carotid atherosclerosis in T2DM patients (detected by measuring carotid intima-media thickness CIMT).
Design and setting: It is observational cross sectional study on T2DM patients from outpatient clinic of fayoum university hospital.
Subjects and methods: Hundred patients with T2DM were included; Group I: statin un-treated, Group II: statin treated, and fifty healthy control persons. Laboratory measurement of total cholesterol, LDL, HDL, and serum CRP levels and carotid duplex scanning were done.
Results: The patients had higher levels of CRP and CIMT than control. There was strong correlation between CIMT and CRP level among group I and II. LDL in diagnosis of atherosclerosis disease illustrated sensitivity (80%) and specificity (4%), while HDL sensitivity (96%) and specificity (36%). CRP showed higher sensitivity (98%) and higher specificity (72%).
Conclusion: CRP level was an important parameter of atherosclerosis with good sensitivity and specificity regardless the level of LDL and HDL.
Keywords: Carotid Intima Media Thickness, C Reactive Protein, Type 2 Diabetes Mellitus.
L Lundby-Christensen, P Almdal, B Carstensen,et al. Carotid intima-media thickness in individuals with and without type 2 diabetes: a reproducibility study. Cardiovascular Diabetology 2010, 9:40 http://dx.doi.org/10.1186/1475-2840-9-40.
ML Bots, MK Palmer, S Dogan, et al: Intensive lipid lowering may reduce progression of carotid atherosclerosis within 12 months of treatment: the METEOR study. J Intern Med 2009, 265(6):698-707. http://dx.doi.org/10.1111/j.1365-2796.2009.02073.x.
JR Crouse, JS Raichlen, WA Riley, et al. for the METEOR Study Group: Effect of Rosuvastatin on Progression of Carotid Intima-Media Thickness in Low-Risk Individuals with Subclinical Atherosclerosis: The METEOR Trial. JAMA: The Journal of the American Medical Association 2007, 297:1344-1353. http://dx.doi.org/10.1001/jama.297.12.1344.
A Kablak-Ziembicka, T Przewlocki, A Sokołowski,et al. Carotid intima-media thickness, hs-CRP and TNF-_ are independently associated with cardiovascular event risk in patients with atherosclerotic occlusive disease. Atherosclerosis 2011; 214: 185–190 http://dx.doi.org/10.1016/j.atherosclerosis.2010.10.017.
L Biasucci, G Biasillo and a Stefanelli. Inflammatory markers, cholesterol and statins: pathophysiological role and clinical importance. Clin Chem Lab Med 2010; 48 (12):1685–1691 http://dx.doi.org/10.1515/CCLM.2010.277.
MG Veller, C Fisher, AN Nicolaides, et al. Measurement for the ultrasonic intima-media complex thickness in normal subjects. J Vasc Surg 1993; 17:719–25 http://dx.doi.org/10.1016/0741-5214 (93)90116-4.
A Pfützner, E Standl, HJ Strotmann, et al. Association of high-sensitive C-reactive protein with advanced stage beta-cell dysfunction and insulin resistance in patients with type 2 diabetes mellitus. Clin Chem Lab Med. 2006; 44 (5):556-60. http://dx.doi.org/10.1515/CCLM.2006.108.
M Soinio, J Marniemi, M Laakso, et al. High sensitivity C-reactive protein and coronary disease mortality in patients with type 2 diabetes. Diabetes Care 2006; 29: 329-33 http://dx.doi.org/10.2337/diacare.29.02.06.dc05-1700.
PM Ridker, JE Buring, NR Cook, and N Rifai. C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14,719 initially healthy American women. Circulation. 2003; 107 (3):391-7. http://dx.doi.org/10.1161/01.CIR.0000055014.62083.05.
S Devaraj, U Singh, I Jialal. Human C-reactive protein and the metabolic syndrome. Curr Opin Lipidol. 2009; 20(3):182-9. http://dx.doi.org/10.1097/MOL.0b013e32832ac03e.
N Kotb, R Gaber, M Salama, et al. Clinical and biochemical predictors of increased carotid intima-media thickness in overweight and obese adolescents with type 2 diabetes, Diabetes & Vascular Disease Research 2011.
M Naghavi, E falk, HS Hecht, ET al.SHAPE Task Force. From vulnerable Plaque to vulnerable patient –part III: Executive summary of the screening for heart Attack prevention and Education (SHAPE) task force report. Am J cardiol 2006; 98(2A) 2H-15H http://dx.doi.org/10.1016/j.amjcard.2006.03.002.
M Xu, Y Bi, Y Chen, et al. Increased C- reactive protein Associates with elevated carotid intima -media thickness in chinese adult with normal Low Density lipoprotein cholesterol. Journal of atherosclerosis and thrombosis 2013; 20.
S Tsimikas, J Willerson and P Ridker. C - reactive protein and Other Emerging Blood Biomarkers to Optimize Risk Stratification of Vulnerable Patients. Journal of the American College of Cardiology 2006 Vol. 47, No. 8 Suppl C 19- 31 http://dx.doi.org/10.1016/j.jacc.2005.10.066.
J Cao, C Thach, T Manolio, et al. C - reactive protein, Carotid Intima-Media Thickness, and Incidence of Ischemic Stroke in the Elderly The Cardiovascular Health Study. Circulation 2003. 108:166-170.) http://dx.doi.org/10.1161/01.CIR.0000079160.07364.6A.
S Kaul, RP Morrissey and GA Diamond. Rosuvastatin, inflammation, C-reactive protein, JUPITER, and primary prevention of cardiovascular disease – a perspective. Arch Intern Med 2010; 170:1073–77 http://dx.doi.org/10.1001/archinternmed.2010.189.
VM Patil, S Chaitanyakumar and V Patil. Diabetic nephropathy and its relation to inflammation. International Journal of Pharmacy and Biological Sciences 2013; 3, 117-127.
C Stehouwer, M Gall, J Twisk, et al. Increased urinary albumin excretion, endothelial dysfunction and chronic low grade inflammation in type 2 diabetes: progressive, interrelated and independently associated with risk of death. Diabetes 2002; 51: 1157-1165 http://dx.doi.org/10.2337/diabetes.51.4.1157.