RELATION OF HIGH SENSITIVITY C-REACTIVE PROTEIN WITH ACUTE MYOCARDIAL INFARCTION IN PATIENTS WITH AND WITHOUT TYPE-2 DIABETES MELLITUS
DOI:
https://doi.org/10.69723/njms.04.02.0557Keywords:
Coronary artery disease, Type 2 diabetes mellitus, Hs-CRP, atherosclerosis, Chronic low grade inflammationAbstract
BACKGROUND: Coronary artery disease (CAD) is a major contributor to cardiac morbidity and mortality. Type 2 diabetes mellitus (T2DM) accelerates atherosclerosis through chronic low-grade inflammation, increasing the risk of CAD and its sequelae. High-sensitivity CRP (Hs-CRP) serves as an independent marker of this inflammation, aiding in risk assessment. This biomarker's significance extends beyond clinical settings into forensic medicine, where it can offer insights into the inflammatory status of individuals prior to death, aiding in the determination of cause of death.
METHODOLOGY: This cross-sectional study conducted from January 2021 to January 2022 employed non-probability consecutive sampling. Ninety acute myocardial infarction (MI) patients of both genders presenting in tertiary care hospitals of Peshawar were included in the study. They were categorized into two groups: Group 1 (T2DM with acute MI) and Group 2 (acute MI without T2DM). Hs-CRP levels were measured using the immunoturbidimetric method. Independent t-test compared mean age and BMI, Chi-square tested gender distribution, and Mann-Whitney U assessed Hs-CRP differences across the groups.
RESULTS: Male subjects had a higher mean age than females. Group 1 patients were significantly older (59.18 ± 8.45 years) than Group 2 (54.82 ± 14.48 years). Median Hs-CRP levels were significantly higher in diabetic MI patients (Group 1: 2.20 mg/L, IQR 7.85) compared to non-diabetic MI patients (Group 2: 0.60 mg/L, IQR 1.35) (p=0.007). Among 90 MI patients, 38 developed complications, Hs-CRP levels were significantly higher in those with complications (p=0.01) and in diabetics with complications as compared to non-diabetics with complications (p=0.03).
CONCLUSION: T2DM patients with MI exhibited elevated Hs-CRP, indicating greater inflammatory burden and higher complication risk. Hs-CRP may aid in risk stratification and includes forensic relevance in assessing pre-mortem inflammation as well.
KEYWORDS: Coronary artery disease, Type 2 diabetes mellitus, Hs-CRP, atherosclerosis, chronic low-grade inflammation
References
Martin SS, Aday AW, Allen NB, Almarzooq ZI, Anderson CAM, Arora P et al. American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Committee. 2025 Heart Disease and Stroke Statistics: A Report of US and Global Data from the American Heart Association. Circulation. 2025 Feb 25; 151(8):e41-e660. https://doi.org/10.1161/CIR.0000000000001303
Severino P, D’Amato A, Pucci M, Infusino F, Birtolo LI, Mariani MV et al. Ischemic Heart Disease and Heart Failure: Role of Coronary Ion Channels. Int J Mol Sci. 2020; 21(9):3167. https://doi.org/10.3390/ijms21093167
Kumar V, Abbas AK, Aster JC. Robbins basic pathology e-book. 11th ed. Philadelphia: Elsevier Health Sciences; 2022.
Sharif S, Van der Graaf Y, Cramer MJ, Kapelle LJ, de Borst GJ, Visseren FLJ, et al. Low-grade inflammation as a risk factor for cardiovascular events and all-cause mortality in patients with type 2 diabetes. Cardiovasc Diabetol. 2021; 20(1):220. https://doi.org/10.1186/s12933-021-01409-0
Longo M, Zatterale F, Naderi J, Parrillo L, Formisano P, Raciti GA, et al. Adipose Tissue Dysfunction as Determinant of Obesity-Associated Metabolic Complications. Int J Mol Sci. 2019 May 13; 20(9):2358. https://doi.org/10.3390/ijms20092358.11
Yan K. Recent advances in the effect of adipose tissue inflammation on insulin resistance.
Cell Signal. 2024 Aug; 120:111229. https://doi.org/10.1016/j.cellsig.2024.111229
Kunz HE, Hart CR, Gries KJ, Parvizi M, Laurenti M, Dalla Man C et al. Adipose tissue macrophage populations and inflammation are associated with systemic inflammation and insulin resistance in obesity. Am J Physiol Endocrinol Metab. 2021 Jul 1; 321(1):E105-E121. https://doi.org/10.1152/ajpendo.00070.2021.
Zatterale F, Longo M, Naderi J, Raciti GA, Desiderio A, Miele C et al. Chronic Adipose Tissue Inflammation Linking Obesity to Insulin Resistance and Type 2 Diabetes. Front Physiol. 2020 Jan 29; 10:1607. https://doi.org/10.3389/fphys.2019.01607.
Kumar V, Abbas AK, Aster JC. Robbins and Cotran pathologic basis of disease. 10th ed. Philadelphia: Elsevier; 2021.
Arroyo-Espliguero R, Viana-Llamas MC, Silva-Obregón A, Avanzas P. The Role of C - reactive protein in Patient Risk Stratification and Treatment. Eur Cardiol. 2021 Jul 7; 16:e28. https://doi.org/10.15420/ecr.2020.49.
Banait T, Wanjari A, Danade V, Banait S, Jain J. Role of High-Sensitivity C-reactive Protein (Hs-CRP) in Non-communicable Diseases: A Review. Cureus. 2022 Oct 12; 14(10):e30225. https://doi.org/10.7759/cureus.30225.
Lucci C, Cosentino N, Genovese S, Campodonico J, Milazzo V, De Metrio M, et al.
Prognostic impact of admission high-sensitivity C-reactive protein in acute myocardial
infarction patients with and without diabetes mellitus. Cardiovasc Diabetol. 2020; 19(1):183. https://doi.org/10.1186/s12933-020-01157-7
Md Najib A, Yusof KM, Wan Shuaib WMA, Shafee MS, Mohd Nor F. A systematic review on the use of C-reactive protein in autopsy practice. Int J Legal Med. 2025 Jan; 139(1):253-265. https://doi.org/10.1007/s00414-024-03328-7
World Health Organization (WHO). STEPS Sample Size Calculator [Excel file]. Geneva: WHO; 2023. Available from: https://cdn.who.int/media/docs/default-source/ncds/ncd-surveillance/steps/sample-size-calculator.xls
Schmitz T, Wein B, Raake P, Heier M, Peters A, Linseisen J, et al. Do patients with
diabetes with new onset acute myocardial infarction present with different symptoms
than non-diabetic patients? Front Cardiovasc Med. 2024; 15(11):1324451.
https://doi.org/10.3389/fcvm.2024.1324451
Krefting J, Graesser C, Novacek S, Voll F, Moggio A, Krueger N, et al. Sex-specific outcomes in myocardial infarction: a dual-cohort analysis using clinical and real-world data. Clin Res Cardiol. 2025 Mar 20. https://doi: 10.1007/s00392-025-02627-2. Epub ahead of print. Erratum in: Clin Res Cardiol. 2025 May 19. https://doi.org/10.1007/s00392-025-02627-2
KAUR, K., D. I. SINGH, and AMITA. “CLINICAL RELEVANCE OF HIGH SENSITIVITY C-REACTIVE PROTEIN IN ACUTE MYOCARDIAL INFARCTION PATIENTS”. Asian J Pharm Clin Res, vol. 17, no. 5, May 2024, pp. 90-93, https://doi:10.22159/ajpcr.2024.v17i5.50981.
Li T, Wang P, Wang X, Liu Z, Zhang Z, Zhang Y et al. Inflammation and Insulin Resistance in Diabetic Chronic Coronary Syndrome Patients. Nutrients. 2023 Jun 19;
(12):2808. https://doi.org/10.3390/nu15122808.
Zhao L, Hu H, Zhang L, Liu Z, Huang Y, Liu Q, Jin L, Zhu M, Zhang L. Inflammation in diabetes complications: molecular mechanisms and therapeutic interventions. Med Comm (2020). 2024 Apr 12; 5(4):e516. https://doi.org/10.1002/mco2.516.
Ullah Z, Ullah A, Khan MA. Incidence of Cardiogenic Shock Among Acute STEMI Cardiac Patients. Pak. J. Med. Health Sci. 2022 Apr 27; 16(03):775. https://doi:10.53350/pjmhs22163775.
Wang WH, Mar GY, Wei KC, Cheng CC, Huang WC. Risk Factors and Outcomes of Heart Failure Following First-Episode of Acute Myocardial Infarction-A Case Series Study of 161,384 Cases. Healthcare (Basel). 2021 Oct 16; 9(10):1382. https://doi.org/10.3390/healthcare9101382
De Luca L, Rosano GMC, Spoletini I. Post-percutaneous coronary intervention angina: From physiopathological mechanisms to individualized treatment. Cardiol J. 2022; 29(5):850-857. https://doi.org/10.5603/CJ.a2021.0042.
Polyakova EA, Mikhaylov EN. The prognostic role of high-sensitivity C-reactive protein in patients with acute myocardial infarction. J Geriatr Cardiol. 2020 Jul 28; 17(7):379-383.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Munir Hussain, Sonia Aziz, Anwar Ul Haq, Naheed Siddiqui, Ghulam Muhayudin, Arshad Parvez
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Readers may “Share-copy and redistribute the material in any medium or format” and “Adapt-remix, transform, and build upon the material”. The readers must give appropriate credit to the source of the material and indicate if changes were made to the material. Readers may not use the material for commercial purposes. The readers may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
.png)
