Value of C-reactive protein in patients with coronary heart disease and concomitant Type-2 diabetes mellitus

Abstract

Coronary heart disease (CHD) is one of the worldwide leading causes of death in patients with type 2 diabetes mellitus (T2DM). This situation may worsen in future since various uncontrollable risk factors mainly diabetes, smoking, obesity, hypercholesterolemia, hypertension etc have been enormously increasing and hence future consequences of CHD might be quite alarming. Vascular indices, circulating inflammatory biomarkers and insulin resistance have important prognostic value, and explain the multifactorial pathophysiological events of atherosclerosis in patients with T2DM. The T2DM diabetes mellitus is almost 90 % of all cases of diabetes. It is documented that atherosclerosis is not developed only by dyslipidemia, but also by inflammation via plague complexity and instability, and a variety of other still unknown factors. However, C-reactive protein (CRP) and especially the high sensitivity CRP (hsCRP)- an acute phase protein of hepatic origin and the inflammatory biomarker or indicator of systemic inflammation/ metaflammation is helpful in predicting inflammation and atherosclerosis. The hsCRP levels may serve as predictor in healthy people for a possibility of their cardiac complications in future and it is considered a marker for the degree of acute and chronic inflammation in CHD, other ischemic diseases, diabetes mellitus and various other disorders presenting inflammation. Despite the diagnostic, prognostic and efficacious role, CRP in average risk adults without symptoms is currently not recommended as a cardiovascular disease (CVD) screening test.  Furthermore, the hsCRP test should not be considered alone and should be combined with elevated levels of cholesterol, low density lipoprotein-cholesterol (LDL-C), triglycerides, glucose level and other variables since beside diabetes, smoking, hypertension and a variety of other factors also increase the risk level of CVD. Statin and other therapeutic approaches have been found efficacious for improving vascular endothelial functions, plaque stability, inflammation and hence, reducing the hsCRP in patients with CHD, T2DM, diabetic coronary heart disease and other ischemic/ inflammatory/ atherosclerotic disorders. Hopefully the future considerations will help identifying common biomarkers for coronary heart disease and type-2 diabetes mellitus and will lead to better management of the patients with co-occurrence of coronary heart disease and type-2 diabetes mellitus.