CRP Measurement Doesn’t Improve Mortality Prediction in Diabetics

Plasma C-reactive protein (CRP) values are associated with mortality risk in patients with Type 2 diabetes, but are no more useful than traditional risk factors for predicting 5-year mortality in this population…

The Italian research team, headed by Dr. Graziella Bruno at the University of Torino notes, “Conflicting results on the incremental usefulness of CRP measurements for cardiovascular prediction have been provided in nondiabetic subjects, whereas no data are available in subjects with Type 2 diabetes.”

CRP measurements were available for 2,381 diabetic patients. During follow-up for a median of 5.4 years, 496 subjects died. The all-cause mortality rate was 42.3 per 1000 person years.

All-cause and cardiovascular mortality rates were significantly higher with CRP >3 mg/mL, independently of other classic risk factors (hazard ratios 1.51 and 1.44, respectively). The association was also found for diabetics who were normoalbuminuric and in those with no evidence of CVD at baseline.

CRP values were positively correlated with body mass index, waist circumference, blood pressure, plasma glucose, hemoglobin A1c, total and LDL cholesterol, apolipoprotein B, uric acid, and albumin excretion rate. There was a negative correlation between CRP and HDL cholesterol and apolipoprotein A1 (p < 0.0001 for all).

Still, the research team maintains, “From a clinical point of view, CRP measurement allows the reclassification of a very limited proportion of patients on the basis of their 5-year probability of surviving.”

“Thus,” they add, “the usefulness of this measurement in addition to other risk factors commonly used in clinical practice by diabetologists does not seem justified at present.”

This conclusion is from the ongoing prospective, population-based Casale Monferrato Study in Italy.

Diabetes. April 2009; 58:798-799, 926-933.