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.

Abstract

AIMS:

We sought to assess the risk of major adverse cardiovascular events (MACE) by utilizing high-sensitivity C-reactive protein (hsCRP) level and low-density lipoprotein cholesterol (LDL-C) in patients with type 2 diabetes and recent acute coronary syndrome.

MATERIALS AND METHODS:

Study participants enrolled in the EXAMINE trial (Clinical trials registration number: NCT00968708) and were stratified by baseline hsCRP levels (<1, 1-3 and >3 mg/L). They were also sub-divided into 4 groups according to baseline hsCRP (≤3 or >3 mg/L) and achieved LDL-C (<70 or ≥70 mg/dL) levels. Among 5380 patients, the MACE rate, a composite of cardiovascular death, non-fatal acute myocardial infarction and non-fatal stroke, was evaluated during the 30 months of follow-up.

RESULTS:

Cumulative incidence of MACE was 11.5% (119 events), 14.6% (209 events) and 18.4% (287 events) in patients with hsCRP levels of <1, 1 to 3 and >3 mg/L, respectively (P < .001). In patients with hsCRP >3 mg/L, the adjusted hazard ratio (95% confidence interval) was 1.42 (1.13, 1.78; P = .002) for MACE compared with patients with hsCRP <1 mg/L. MACE cumulative incidences were 11.0% (128 events), 14.4% (100 events), 15.6% (194 events) and 21.3% (182 events) in patients with low LDL-C and low hsCRP, low LDL-C and high hsCRP, high LDL-C and low hsCRP, and high LDL-C and high hsCRP levels, respectively (P < .001).

CONCLUSIONS:

Levels of hsCRP were associated with recurrent cardiovascular events in patients with type 2 diabetes and recent acute coronary syndrome, and this association appears to be independent of and additive to the achieved LDL-C level.

• Authors: You-Cheol Hwang, David A Morrow, Christopher P Cannon, Yuyin Liu, Richard Bergenstal, Simon Heller, Cyrus Mehta, William Cushman, George L Bakris, Faiez Zannad, William B White
• Journal: Diabetes, obesity & metabolism (Diabetes Obes Metab) Vol. 20 Issue 3 Pg. 654-659 (03 2018) ISSN: 1463-1326 [Electronic] England
• PMID: 29064626 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2017 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

Chemical References

• Cholesterol, LDL
• Hypoglycemic Agents
• Piperidines
• Uracil
• C-Reactive Protein
• alogliptin

Topics

• Acute Coronary Syndrome
• C-Reactive Protein (metabolism)
• Cholesterol, LDL (metabolism)
• Diabetes Mellitus, Type 2 (mortality)
• Diabetic Angiopathies (drug therapy)
• Double-Blind Method
• Female
• Heart Failure (mortality)
• Humans
• Hypoglycemic Agents (therapeutic use)
• Male
• Middle Aged
• Myocardial Infarction (mortality)
• Myocardial Revascularization (mortality)
• Piperidines (therapeutic use)
• Standard of Care
• Treatment Outcome
• Uracil (analogs & derivatives, therapeutic use)