title: Changes in C-reactive protein levels before type 2 diabetes and cardiovascular death: the Whitehall II study.
abstract: OBJECTIVE
  Prospective studies show that high C-reactive protein (CRP) levels predict diabetes and cardiovascular disease (CVD), but changes in this marker preceding disease onset are not well characterized. This study describes CRP trajectories prior to type 2 diabetes onset and fatal CVD.
  
  
  METHODS
  In a prospective cohort of 7350 British civil servants (70% male, mean age 51 years), 558 incident type 2 diabetes cases (75-g oral glucose tolerance test, doctor's diagnosis, or self-report) and 125 certified fatal cardiovascular events were observed during a median follow-up of >14 years. Trajectories of logarithmically transformed CRP levels prior to incident diabetes or fatal cardiovascular event (cases), or the end of follow-up (controls) were calculated using multilevel modeling.
  
  
  RESULTS
  Baseline CRP levels were higher among participants who developed diabetes (median (interquartile range) 1.44 (2.39) vs 0.78 (1.21) mg/l) or fatal CVD (1.49 (2.47) vs 0.84 (1.30) mg/l) compared with controls (both P<0.0001). In models adjusted for age, sex, body mass index, ethnicity, and employment grade, CRP levels increased with time among both incident diabetes cases and controls (P<0.0001), but this increase was less steep for cases group (P<0.05). CRP levels followed increasing linear trajectories in fatal cardiovascular cases and controls (P<0.0001) with no slope difference between the groups.
  
  
  CONCLUSIONS
  CRP levels were higher among those who subsequently developed diabetes or died from CVD. For type 2 diabetes, age-related increase in CRP levels was less steep in the cases group than in controls, whereas for fatal CVD these trajectories were parallel.
authors.affiliation: Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6 BT, UK. a.tabak@ucl.ac.uk
authors.forename: A G
authors.initials: AG
authors.lastname: Tabák
authors.forename: M
authors.initials: M
authors.lastname: Kivimäki
authors.forename: E J
authors.initials: EJ
authors.lastname: Brunner
authors.forename: G D
authors.initials: GD
authors.lastname: Lowe
authors.forename: M
authors.initials: M
authors.lastname: Jokela
authors.forename: T N
authors.initials: TN
authors.lastname: Akbaraly
authors.forename: A
authors.initials: A
authors.lastname: Singh-Manoux
authors.forename: J E
authors.initials: JE
authors.lastname: Ferrie
authors.forename: D R
authors.initials: DR
authors.lastname: Witte
mesh_terms: D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000378:metabolism* / Q000401:mortality*; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D002097:C-Reactive Protein