Inflammation, Atherosclerosis, and Aspects of Insulin Action

  1. Zachary T. Bloomgarden, MD
  1. Zachary T. Bloomgarden, MD, is a practicing endocrinologist in New York, New York, and is affiliated with the Division of Endocrinology, Mount Sinai School of Medicine, New York, New York.

    C-reactive protein

    At the American Diabetes Association Postgraduate Course held in New York on 5 February 2005, Alan Chait (Seattle, WA) discussed C-reactive protein (CRP). Although it may not be as predictive of cardiovascular disease (CVD) as cholesterol, hypertension, and cigarette use (1), CRP appears to be the strongest “novel” risk factor thus far identified, showing greater predictive power than homocysteine, interleukin (IL)-6 (2), and other inflammatory markers, such as serum amyloid A (SAA), circulating levels of which parallel CRP, and intracellular adhesion molecule (ICAM)-1. CRP adds prognostic information at all levels of risk based on Framingham score (3).

    Chait noted that several studies have shown that persons with diabetes without prior myocardial infarction have increased CVD risk, either to the same degree as persons without diabetes but with prior evidence of CVD (4,5) or to a somewhat lower level (6). An important potential linkage between diabetes and atherosclerosis may involve inflammatory factors. CRP is increased by diabetes, as well as by obesity, estrogen, cigarette smoking, chronic infections such as gingivitis, and chronic inflammatory diseases such as rheumatoid arthritis, while being decreased by statins (7), fibrates, niacin, aspirin (8), α-tocopherol (in high dose), thiazolidinediones (TZDs) (9), alcohol, and lifestyle factors such as exercise and weight loss (10), with weight loss also decreasing IL-6 levels (11). CRP increases if one simply counts the number of positive metabolic syndrome markers, dyslipidemia, upper-body obesity, hypertension, and hyperglycemia (12). Furthermore, Chait noted, CVD prevalence is greater in persons with metabolic syndrome without diabetes than in those with diabetes who do not have the metabolic syndrome (13). Similarly, a study of persons from Botnia in Finland showed, that for all levels of glycemia, the presence of metabolic syndrome is associated with an increase in CVD prevalence (14). The metabolic syndrome, then, is both associated …

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