Association of high sensitivity C-reactive protein (hsCRP) and tumour necrosis factor-alpha (TNF-alpha) with carotid intimal medial thickness in subjects with different grades of glucose intolerance--the Chennai Urban Rural Epidemiology Study (CURES-31).

OBJECTIVE

To assess the association of high sensitivity C-Reactive Protein [hsCRP] and Tumour Necrosis Factor-alpha [TNF-alpha] with IMT in Asian Indians with different grades of glucose intolerance.

DESIGN AND METHODS

Subjects with normal glucose tolerance NGT, impaired glucose tolerance [IGT] (n=150) and type 2 diabetes (DM) (n=150) were recruited from the Chennai Urban Rural Epidemiology Study [CURES], in south India. hsCRP was estimated by nephelometry and TNF-alpha by enzyme linked immunosorbent assay. Carotid IMT was assessed by high resolution B-mode ultrasonography.

RESULTS

hsCRP and TNF-alpha levels were higher in those with DM [p<0.001] and IGT [p<0.001] compared to NGT. In linear regression analysis, both hsCRP [p=0.003] and TNF-alpha [p=0.001] showed an association with IMT among NGT subjects even after adjusting for age and gender. Among IGT subjects, TNF-alpha was associated with IMT [p<0.001], while no association was observed either with hsCRP or TNF-alpha in diabetic subjects. In NGT subjects, mean IMT was highest in those with high values [III tertile] of both TNF-alpha and hsCRP [0.83+/-0.1 mm; p<0.001] followed by those with high TNF-alpha+low hsCRP [0.74+/-0.09 mm; p<0.001], high hsCRPlow TNF-alpha [0.67+/-0.09 mm; p<0.001], and lowest in those with both low TNF-alpha and hsCRP [I tertile] [0.63+/-0.05 mm.

CONCLUSION

We conclude that in Asian Indians 1. Levels of hsCRP and TNF-alpha increase with increasing severity of glucose intolerance 2. Both hsCRP and TNF-alpha are associated with IMT in NGT subjects while TNF-alpha alone is associated with IMT in IGT subjects 3. hsCRP and TNF-alpha have a cumulative effect on mean IMT values in NGT subjects.