C-Reactive Protein and 5-Year Survival in Type 2 Diabetes The Casale Monferrato Study

被引:55
作者
Bruno, Graziella [1 ]
Fornengo, Paolo [1 ]
Novelli, Giulia [1 ]
Panero, Francesco [1 ]
Perotto, Massimo [1 ]
Segre, Olivia [1 ]
Zucco, Chiara [1 ]
Deambrogio, PierCarlo [2 ]
Bargero, Giuseppe [2 ]
Perin, Paolo Cavallo [1 ]
机构
[1] Univ Turin, Dept Internal Med, Turin, Italy
[2] Santo Spirito Hosp, Casale Monferrato, Alessandria, Italy
关键词
CORONARY-HEART-DISEASE; QUALITY-OF-CARE; CARDIOVASCULAR-DISEASE; METABOLIC SYNDROME; INFLAMMATORY MARKERS; RISK PREDICTION; MEN; MORTALITY; EVENTS; ADULTS;
D O I
10.2337/db08-0900
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE-To determine to what extent plasma C-reactive protein (CRP) values influence 5-year all-cause and cardiovascular mortality in type 2 diabetic individuals, independently of albumin excretion rate (AER) and other cardiovascular risk factors, and its incremental usefulness for predicting individual risk of mortality. RESEARCH DESIGN AND METHODS-Measurements of CRP were performed in 2,381 of 3,249 (73.3%) subjects as part of the population-based Casale Monferrato Study. Its association with 5-year all-cause and cardiovascular mortality was assessed with multivariate Cox proportional hazards modeling. The C statistic and measures of calibration and global fit were also assessed. RESULTS-Results are based on 496 deaths in 11.717 person-years of observations (median follow-up 5.4 years). With respect to subjects with CRP <= 3 mg/l, those with higher values had an adjusted hazard ratio (HR) of 1.51 (95% CI 1.18-1.92) for all-cause mortality and 1.44 (0.99-2.08) for cardiovascular mortality. In normoalbuminuric subjects, respective HRs of CRP were 1.56 (1.13-2.15) and 1.65 (1.00-2.74), AER being neither a modifier nor a confounder of CRP association. In analysis limited to diabetic subjects without cardiovascular disease (CVD), adjusted HRs were 1.67 (1.24-2.24) for all-cause mortality and 1.36 (0.83-2.24) for cardiovascular mortality. The improvement in individual risk assessment was marginal when measured with various statistical measures of model discrimination, calibration, and global fit. CONCLUSIONS-CRP measurement is independently associated with short-term mortality risk in type 2 diabetic individuals, even in normoalbuminuric subjects and in those without a previous diagnosis of CVD. Its clinical usefulness in individual assessment of 5-year risk of mortality, however, is limited. Diabetes 58:926-933, 2009
引用
收藏
页码:926 / 933
页数:8
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