Value of serum glycated albumin and high-sensitivity C-reactive protein levels in the prediction of presence of coronary artery disease in patients with type 2 diabetes.
BACKGROUND
Coronary artery disease (CAD) is a major vascular complication of diabetes mellitus and reveals high mortality. Up to 30% of diabetic patients with myocardial ischemia remain asymptomatic and are associated with worse prognosis compared to non-diabetic counterpart, which warrants routine screening for CAD in diabetic population. The purpose of this study was to evaluate the clinical value of serum glycated albumin and high-sensitivity C-reactive protein (hs-CRP) levels in predicting the presence of CAD in patients with type 2 diabetes.


METHODS
Three hundred and twenty-four patients with type 2 diabetes were divided into two groups based on presence (CAD group, n = 241) or absence (control group, n = 83) of angiographically-documented CAD (lumen diameter narrowing > or =70%). Serum levels of glycated albumin and hs-CRP as well as serum concentrations of glucose, lipids, creatinine, blood urea nitrogen and uric acid were measured in both groups. Predictors of CAD were determined using multivariate logistic regression model and receiver-operating characteristic (ROC) curves.


RESULTS
Serum glycated albumin and hs-CRP levels were significantly increased in diabetic patients with CAD. Multivariate regression analysis revealed that male gender, age, serum levels of glycated albumin, hs-CRP, creatinine and lipoprotein (a) were independent predictors for CAD. Areas under the curve of glycated albumin and hs-CRP and for regression model were 0.654 (95%CI 0.579-0.730, P < 0.001), 0.721 (95%CI 0.658-0.785, P < 0.001) and 0.824 (95% CI 0.768-0.879, P < 0.001), respectively. The optimal values of cut-off point were 18.7% (sensitivity 67.9%, specificity 60.0%) for glycated albumin and 5.2 mg/l (sensitivity 72.2%, specificity 60.0%) for hs-CRP to predict CAD. Logistic regression model was defined as: P/(1-P) = EXP(-1.5 + 1.265 gender + 0.812 age + 1.24 glycated albumin + 0.953 hs-CRP + 0.902 lipoprotein(a) + 1.918 creatinine). The optimal probability value for predicting CAD in type 2 diabetic patients was 0.648 (sensitivity 82.3%, specificity 68.6%).


CONCLUSIONS
Serum glycated albumin and hs-CRP levels were significantly elevated in patients with type 2 diabetes and CAD. The logistic regression model incorporating with glycated albumin, hs-CRP and other major risk factors of atherosclerosis may be useful for screening CAD in patients with type 2 diabetes.
Pu
Li Jin
LJ
Department of Cardiology, Institute of Cardiovascular Diseases, Rui Jin Hospital, Jiaotong Univerisity Medical School, Shanghai, People's Republic of China. Plj476@yahoo.com.cn
Lu
Lin
L
Xu
Xue Wei
XW
Zhang
Rui Yan
RY
Zhang
Qi
Q
Zhang
Jian Sheng
JS
Hu
Jian
J
Yang
Zheng Kun
ZK
Ding
Feng Hua
FH
Chen
Qiu Jin
QJ
Lou
Sheng
S
Shen
Jie
J
Fang
Dan Hong
DH
Shen
Wei Feng
WF
D015415:Biomarkers / Q000097:blood*; D001786:Blood Glucose / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D003925:Diabetic Angiopathies / Q000097:blood* / Q000000981:diagnostic imaging; D017127:Glycation End Products, Advanced; D006801:Humans; D019518:Postprandial Period; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012709:Serum Albumin / Q000032:analysis*; D000093423:Glycated Serum Albumin
D015415:Biomarkers; D001786:Blood Glucose; D017127:Glycation End Products, Advanced; D012709:Serum Albumin; D002097:C-Reactive Protein; D000093423:Glycated Serum Albumin