title: Inflammation and insulin resistance are independently related to all-cause of death and cardiovascular events in Japanese patients with type 2 diabetes mellitus.
abstract: Insulin resistance (IR)/hyperinsulinemia and low-grade inflammation (high-sensitivity C-reactive protein [hs-CRP]) can predict cardiovascular disease. However, because IR and inflammation (IF) have not been evaluated simultaneously, it is not known whether IR and IF are independently related to cardiovascular disease. Furthermore, the combined effect of IR and IF on the prediction of cardiovascular disease is presently unknown. Thus, we measured insulin sensitivity (K index of the insulin tolerance test; KITT) and hs-CRP in 350 Japanese patients with type 2 diabetes, and followed them for 1-7 years (mean, 4.5 years). During the follow-up, 33 patients died and 53 patients developed non-fatal coronary artery disease or stroke (endpoint). Age, systolic blood pressure, current smoking, past history of cardiovascular disease, KITT, and hs-CRP independently and significantly correlated with endpoint. One-S.D. difference was associated with a significant increase of relative risk in KITT (1.45; 95% CI 1.09-1.91) and hs-CRP (1.30; 1.04-1.67). When patients were subdivided to tertile, the relative risk in the highest tertile of KITT was 1.76 (95% CI 1.01-3.11) and hs-CRP was 2.00 (1.03-3.85) compared with the patients with lowest tertile. The relative risk in the highest tertile of both KITT and hs-CRP was 5.32 (1.18-24.0) compared with the lowest tertile of both values. In conclusion, low-grade IF and IR are independently related to all-cause of death and cardiovascular disease in Japanese patients with type 2 diabetes. Coexistence of low-grade IF and IR amplify this effect.
authors.affiliation: Department of Diabetes and Metabolism, Sasebo Chuo Hospital, 15 Yamato-cho, Sasebo, Nagasaki 857-1195, Japan. dmkmatsu@hakujyujikai.or.jp
authors.forename: Kazunari
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Sera
authors.forename: Yasuyo
authors.initials: Y
authors.lastname: Abe
authors.forename: Yukitaka
authors.initials: Y
authors.lastname: Ueki
authors.forename: Tan
authors.initials: T
authors.lastname: Tominaga
authors.forename: Seibei
authors.initials: S
authors.lastname: Miyake
mesh_terms: D000367:Age Factors; D001794:Blood Pressure / Q000502:physiology; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases / Q000209:etiology*; D002423:Cause of Death; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006801:Humans; D007249:Inflammation; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects
chemical_list: D002097:C-Reactive Protein