Chinese Medical Journal 2008; 121(24):2509-2516
2509
Original article
High sensitive C-reactive protein, adiponectin, and urine albumin excretion rate in Chinese coronary artery disease patients with different glucose tolerance status
GUI Ming-hui, HONG Jie, L An-kang, CHEN Ying, SHEN Wei-feng, LI Xiao-ying and NING Guang Keywords: C-reactive protein; adiponectin; urine albumin excretion rate; diabetes mellitus, type 2; coronary artery disease
Background Serum high sensitive C-reactive protein (hs-CRP), adiponectin levels and urine albumin excretion rate (UAER) are probably associated with inflammation and atherosclerosis. The aim of this study was to determine the three markers in coronary artery disease (CAD) subjects with different glucose tolerance status in a Chinese population and further explore the levels of the three markers in these subjects and the possible association of these markers with CAD risk factors and the severity of CAD as well. Methods A total of 242 subjects with angiographically documented CAD were recruited, and then assigned to three groups: the normal glucose tolerance (NGT) + CAD group, including 100 CAD patients with NGT; the impaired glucose tolerance (IGT) + CAD group, 40 CAD patients with IGT; the type 2 diabetes mellitus (T2DM) + CAD group, 102 CAD patients with T2DM. Serum hs-CRP, adiponectin levels as well as UAER were measured in all subjects. Results Serum hs-CRP levels were increased in the T2DM + CAD group compared with the NGT + CAD group (4.71±2.59) vs (3.60±2.46) mg/L, P=0.037. Serum adiponectin levels were gradually decreased from the NGT + CAD to IGT + CAD to T2DM + CAD groups, (5.99±1.84), (5.82±1.72) and (4.65±1.71) mg/L, P=0.002 and 0.040 for NGT + CAD and IGT + CAD groups vs T2DM + CAD group, respectively. While the UAER was gradually increased from the NGT + CAD to IGT + CAD to T2DM + CAD groups, (6.42±2.51), (6.89±2.94) and (15.03±4.22) g/min (P <0.001) for NGT + CAD and IGT + CAD groups vs T2DM + CAD group. Multiple linear stepwise regression analysis showed that waist-hip ratio (WHR) and low density lipoprotein cholesterol (LDL-C) were the significant determinants of serum hs-CRP levels; triglyceride (TG), high density lipoprotein cholesterol (HDL-C), age, WHR, T2DM, 2-hour serum insulin (2hINS), sex, and apolipoprotein B were the significant determinants of serum adiponectin levels; and systolic blood pressure (SBP), T2DM, and hemoglobin A1c (HbA1c) were the significant determinants of UAER in all subjects (R2= 0.070, 0.352, and 0.214, respectively). However, no significant correlation was seen for hs-CRP, adiponectin and UAER with the severity of CAD. Hs-CRP levels were significantly correlated with UAER. Conclusions There was a trend of increased serum hs-CRP levels from the NGT + CAD to IGT + CAD to T2DM + CAD groups, though it only showed significance in the T2DM + CAD group compared with the NGT + CAD group. Serum adiponectin levels were decreased and UAER was increased from the NGT + CAD to IGT + CAD to T2DM + CAD groups. Increased UAER and serum hs-CRP, and decreased adiponectin levels were associated with traditional CAD risk factors but failed to be correlated with the severity of CAD. Hs-CRP levels were significantly correlated with UAER. Department of Endocrinology and Metabolism, Shanghai Clinical Chin Med J 2008;121(24):2509-2516 Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases (Gui MH, Hong J, Chen Y, Li XY and Ning G), Department of Cardiology (Lü AK and Shen WF), oronary artery disease (CAD), as one of the major Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, complications of type 2 diabetes mellitus (T2DM), is Shanghai 200025, China well known to be an atherosclerotic disease. The Correspondence to: Prof. NING Guang, Department of contribution of inflammation to the initiation and Endocrinology and Metabolism, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine progression of atherosclerosis is receiving increasing and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong attention. Many markers have been implicated in this University School of Medicine, Shanghai 200025, China (Tel: process. 86-21-64370045 ext 665344. Fax: 86-21-64373514. Email: guangning@medmail.com.cn) C-reactive protein (CRP), the classic acute-phase protein, GUI Ming-hui now works in the Department of Endocrinology and Metabolism, Zhongshan Hospital Affiliated to Fudan University, is a sensitive marker of inflammation, and increased CRP Shanghai 200032, China. was associated with not only CAD and DM but also their 1-4 GUI Ming-hui and HONG Jie contributed equally to this work. mortality. Recently, CRP levels have been shown to be This study was supported by grants from the National Natural significantly associated with several cardiovascular risk Science Foundation of China (No. 30570880), 973 Project (No. factors, such as age, smoking status, lipoprotein(a), body 2006CB503904), and Science and Technology Foundation of the 5,6 mass index (BMI), hypertension and diabetes. Science and Technology Commission of Shanghai (No. 04DZ19502).

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