CONGRESSO ADA 2009 - TEMA LIVRE 2

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Impact of diabetes on high-sensitive C-reactive protein in patients with acute and chronic coronary syndromes.

Jose Roberto Matos Souza, Daniela Schiavo, Romulo Tadeu Dias de Oliveira, Marcos Antonio Tambascia, Maria Heloisa Blotta, Otavio Rizzi Coelho, Bruno Geloneze

Introduction

Current evidence has implicated the role of inflammation in atherogenesis and plaque destabilization. Inflammatory cytokines may attenuate interstitial collagen synthesis, increase matrix degradation, and promote apoptosis in several atheroma-associated cell types, and all these cellular events may enhance plaque vulnerability. Hyperglycemia per se is a risk factor for poor outcome after myocardial infarction. An enhanced inflammatory state is probably related to a worst cardiovascular prognosis in type 2 diabetic patients.

Aims and Methods: To study the influence of the diabetic state on inflammation in acute and chronic coronary syndrome (ACS and CCS, respectively). High-sensitive C-reactive protein (hsCRP), a surrogate marker of inflammation, were measured in 74 type 2 diabetic subjects (38 with non ST-elevation myocardial infarction and 36 with stable angina), and 38 non-diabetic subjects (22 with non ST-elevation myocardial infarction and 16 with stable angina).The inclusion criteria for ACS were: 2 episodes of resting angina or 1 episode of more than 15 minutes in a 24 h period without elevation of ST-segment or with T wave inversion in the ECG. hs-CRP was measured by nephelometry.

Results: In the ACS group, hsCRP was 2.6 times greater in the diabetic group in comparison to non-diabetic subjects [4.75(0.97) vs. 1.83(0.77) mg/L, p<0.01]. In the CCS group, hsCRP was greater in diabetics [1.75 mg/L (0.22) vs. 0.55 mg/L (0.18) mg/L, p<0.05]. Hence, hsCRP is similar in T2DM with CCS to non-DM with ACS [1.75 mg/L (0.38) vs. 1,83 mg/L (0.46) mg/L].

Conclusions: Elevated plasma concentrations of the inflammatory biomarker high-sensitivity C-reactive protein is observed in diabetic patients in both acute and chronic coronary syndromes. The diabetic-related amplification of inflammation in acute and chronic conditions could be related with the worst prognosis of coronary disease in T2DM.