title: C-peptide levels are associated with mortality and cardiovascular mortality in patients undergoing angiography: the LURIC study.
abstract: OBJECTIVE
  C-peptide is a proinsulin cleavage product released from the pancreas in amounts equimolar to insulin, and elevated levels of C-peptide have been found in patients with insulin resistance and early type 2 diabetes mellitus. Recent data suggest that C-peptide could play a causal role in the pathophysiology of vascular disease, but nothing is known about the prognostic value of C-peptide concentrations in the circulation.
  
  
  METHODS
  We examined whether C-peptide is associated with cardiovascular and total mortality in 2,306 patients from the Ludwigshafen Risk and Cardiovascular Health Study who underwent coronary angiography at baseline (1997-2000).
  
  
  RESULTS
  During a mean follow-up of 7.6 years, 440 deaths (19.1%) occurred, 252 (10.9%) of which were due to cardiovascular causes. Age- and sex-adjusted hazard ratios (HRs) in the third compared with the first tertile of C-peptide were 1.46 (95% CI 1.15-1.85; P = 0.002) for all cause and 1.58 (1.15-2.18; P = 0.005) for cardiovascular mortality. After further adjustment for common risk factors as well as markers of glucose metabolism, these HRs remained significant at 1.46 (1.10-1.93; P = 0.008) and 1.55 (1.07-2.24; P = 0.022), respectively. Moreover, patients in higher tertiles of C-peptide exhibited higher levels of markers of endothelial dysfunction and atherosclerosis as well as a more severe extent of coronary lesions.
  
  
  CONCLUSIONS
  In patients undergoing coronary angiography, C-peptide levels are independently associated with all cause and cardiovascular mortality as well as presence and severity of coronary artery disease. Further studies are needed to examine a potential causal role of C-peptide in atherogenesis in humans.
authors.affiliation: Department of Internal Medicine I, University Hospital Aachen, Aachen, Germany. nmarx@ukaachen.de
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Marx
authors.forename: Guenther
authors.initials: G
authors.lastname: Silbernagel
authors.forename: Vincent
authors.initials: V
authors.lastname: Brandenburg
authors.forename: Mathias
authors.initials: M
authors.lastname: Burgmaier
authors.forename: Marcus E
authors.initials: ME
authors.lastname: Kleber
authors.forename: Tanja B
authors.initials: TB
authors.lastname: Grammer
authors.forename: Bernhard R
authors.initials: BR
authors.lastname: Winkelmann
authors.forename: Bernhard O
authors.initials: BO
authors.lastname: Boehm
authors.forename: Winfried
authors.initials: W
authors.lastname: März
mesh_terms: D000368:Aged; D001161:Arteriosclerosis / Q000097:blood / Q000401:mortality / Q000473:pathology; D002096:C-Peptide / Q000097:blood*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality* / Q000473:pathology; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality
chemical_list: D002096:C-Peptide