Schulze Matthias B, Rimm Eric B, Li Tricia, Rifai Nader, Stampfer Meir J, Hu Frank B
Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
Diabetes Care. 2004 Apr;27(4):889-94. doi: 10.2337/diacare.27.4.889.
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.
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.
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.
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.
多项大型前瞻性研究表明，C反应蛋白（CRP）的基线水平是表面健康个体发生心血管事件的独立预测指标。然而，目前关于CRP是否能预测糖尿病患者心血管事件的前瞻性数据有限。
为研究2型糖尿病男性患者血浆CRP水平与心血管事件发生率之间的关联，我们前瞻性地随访了一组746名年龄在46 - 81岁之间的美国男性，这些男性在1993 - 1994年采血时无心血管疾病。
在平均5年的随访期（3986人年）内，我们通过医疗记录确认了103例心血管事件（18例心肌梗死、70例冠状动脉搭桥术或血管成形术以及15例中风）。在调整了年龄、体重指数、吸烟、饮酒、体力活动、冠心病家族史、高血压病史、高血清胆固醇病史、阿司匹林使用情况、空腹状态以及纤维蛋白原、肌酐、糖化血红蛋白（HbA1c）和非高密度脂蛋白胆固醇水平后，CRP仍与心血管事件风险增加显著相关。四分位数的相对风险分别为1.00、1.51、2.52和2.62（95%可信区间：1.29 - 5.32；趋势P值：0.011）。我们未观察到低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、非高密度脂蛋白胆固醇、载脂蛋白B、糖化血红蛋白（HbA1c）、纤维蛋白原的血浆水平或体重指数对结果产生效应修正。
糖尿病男性患者血浆CRP水平升高与心血管事件发生风险增加相关，独立于目前已确定的生活方式风险因素、血脂和血糖控制情况。
