High levels of C-peptide in patients newly diagnosed with type 2 diabetes are indicative of a greater risk for a cardiovascular event later on, suggests a study presented at the 58th EASD Annual Meeting in Stockholm, Sweden.^1,2

Participants from the DD2 (Danes with type 2 diabetes) study, who had been newly diagnosed with type 2 diabetes, but no history of hospitalization for cardiovascular events were included in the present study. Out of the 13,066 study subjects, serum hsCRP at baseline was measured in 7301 patients, while C-peptide was measured in 5765 patients. They were followed up for occurrence of an incident cardiovascular event such as myocardial infarction, stroke, coronary revascularization and cardiac-related as well as all-cause mortality over a period of 4.8 years (median). The researchers aimed to examine if serum hsCRP and C-peptide were linked with major adverse cardiovascular events in patients with recent-onset type 2 diabetes.

At the end of the follow-up period, patients who had high hsCRP levels, 3 mg/L or higher, were at a much higher risk of suffering a cardiovascular event (5.4%) compared to those in whom the hsCRP levels were less than 1 mg/L (4.4%) with adjusted hazard ratio of 1.45. The all-cause mortality, mainly cancer-related, was also significantly increased in this group.

Results also showed that patients with elevated hsCRP and C-peptide levels were at the greatest risk of a cardiovascular event (aHR 1.62) and death (aHR 2.42) due to any cause than those with hsCRP less than 3 mg/L and C-peptide less than 1470 pmol/L. However, the odds of occurrence of a cardiovascular event were higher in patients with only high C-peptide levels (aHR 1.54) vis a vis those with high hsCRP alone (aHR 1.37). When all-cause mortality was examined, the risk of all-cause mortality was increased nearly 2-folds with high hsCRP levels alone (aHR 1.90) than high C-peptide levels alone (aHR1.15).

Insulin resistance is a risk factor for cardiovascular disease, even in patients with good glycemic control. Targeting insulin resistance may reduce the risk of cardiovascular complications. hsCRP is a marker of inflammation and C-peptide is a marker of insulin resistance. Based on their observations, the researchers concluded C-peptide was “a more accurate predictor of CVE risk than hsCRP” in patients with newly diagnosed type 2 diabetes.   

References

1. Kjaergaard AD, et al. Abstract 43. C-reactive protein, C-peptide and risk of cardiovascular events and mortality after type 2 diabetes diagnosis: a Danish cohort study. Available at:https://www.easd.org/virtualmeeting/home.html#!resources/c-reactive-protein-c-peptide-and-risk-of-cardiovascual-events-and-mortality-after-type-2-diabetes-diagnosis-a-danish-cohort-study-440b9a9c-5ef6-47d7-b0b4-fe6a1b36df3c.
2. https://diabetes.medicinematters.com/easd-2022/risk-factors/biomarkers-crp-c-peptide-cvd/23521884.