This study sought to investigate the relationship between C-reactive protein (CRP) and 5-year all-cause and cardiovascular mortality in 2,381 patients with type 2 diabetes. Compared to individuals with CRP ≤3 mg/l, those with elevated CRP concentrations had a significantly higher adjusted hazard ratio for all-cause mortality (1.51, 95% CI: 1.18-1.92). In normoalbuminuric subjects, the hazard ratios for individuals with CRP >3 mg/l were 1.56 (95% CI: 1.13-2.56) for all-cause mortality and 1.65 (95% CI: 1.00-2.74) for cardiovascular mortality. Moreover, after excluding type 2 diabetic patients with prior cardiovascular disease, only all-cause mortality was significantly increased in individuals with elevated CRP concentrations (1.67, 95% CI: 1.24-2.24). Finally, the improvement in individual risk assessment provided by CRP was only marginal. This paper was accompanied by an editorial written by Dr. Sattar and Hingorani in which the authors raised the point that although several studies have observed a relationship between CRP and the risk of cardiovascular disease, whether CRP is causally involved in atherogenesis or whether it helps to better discriminate cardiovascular disease events remains controversial. Regarding the association between CRP and cardiovascular disease in diabetic patients, little data is available and studies in such populations as the one examined by Bruno G. et al. are therefore welcomed. Although there is a lot of enthusiasm surrounding the possible added value of CRP in cardiovascular disease risk assessment, higher-resolution observational epidemiology, continued genetic epidemiology and, eventually, specific CRP inhibitors are needed to draw further conclusions on the causal role and utility of CRP as a risk predictor.
Documentation centre