Correlación entre niveles séricos de PCR ultrasensible y factores de riesgo cardiovasculares en pacientes adultos con Diabetes Mellitus tipo 2
Palabras clave:
proteína C reactiva ultrasensible (PCR US), Diabetes Mellitus tipo 2 (DMT2), riesgo cardiovascular (RCV), correlación.
Resumen
Introducción: La población de Latinoamérica está viviendo un proceso de transición epidemiológica en las últimas décadas, adquiriendo estilos de vida urbana industriales, que típicamente se asocian a un incremento de la prevalencia de enfermedades cardiovasculares y diabetes.
Materiales y Métodos: Se trata de un estudio con diseño observacional, analítico, transversal, para medir el grado de correlación que existe entre los factores de riesgo cardiovasculares tradicionales y los niveles de PCR US, en una población de pacientes Diabéticos tipo 2.
Resultados: Se encontró una correlación positiva significativa moderada entre los niveles de PCR US y los valores de hemoglobina glicosilada (r. 0,55, p 0,01), positiva débil con índice de masa corporal (r. 0,27, p 0,05) y perímetro abdominal de mujeres (r. 0,37, p 0,01) y hombres (r. 0,25, p 0,05). Se obtuvo una correlación positiva muy débil significativa entre PCR US con tiempo de diagnóstico (r. 0,19, p 0,05), fibrinógeno (r. 0,18, p 0,01), niveles de tensión arterial (r. 0,17, p 0,05). Una correlación negativa muy débil, no significativa con género femenino (r. -0.153, p 0,057) y tabaquismo (r. 0,11, p 0,16). No se encontró correlación entre PCR US con edad, hipertensión arterial, perfil lipídico y score Framingham.
Conclusión: Se observó correlación positiva estadísticamente significativa entre niveles de PCR US y Hemoglobina glucosilada, Índice de Masa Corporal, perímetro abdominal, niveles de fibrinógeno, tensión arterial y tiempo diagnóstico en pacientes con Diabetes tipo 2.
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Woloshin S, Schwartz LM. Distribution of C-reactive protein values in the United States. N Engl J Med 2005; 352:1611.
Ridker PM. Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation 2003; 107:363
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Charles T. Valmadrid, MD, MPH; Ronald Klein, MD, MPH; Scot E. Moss, MA; Barbara E. K. Klein, MD, MPH: The Risk of Cardiovascular Disease MortalityAssociated with Microalbuminuria and Gross Proteinuria in Persons With Older-Onset Diabetes Mellitus. Arch Intern Med. 2000; 160:1093-1100
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Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998; 352:837.
The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med 1993; 329:977.
D'Agostino RB Sr, Vasan RS, Pencina MJ, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 2008; 117:743.
Langer RD, Pradhan AD, Lewis CE, et al. Baseline associations between postmenopausal hormone therapy and inflammatory, haemostatic, and lipid biomarkers of coronary heart disease. The Women's Health Initiative Observational Study. Thromb Haemost 2005; 93:1108.
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Tillett WS, Francis T. Serological Reactions In Pneumonia With A Non-Protein Somatic Fraction Of Pneumococcus. J Exp Med 1930; 52:561.
Black S, Kushner I, Samols D. C-reactive Protein. J Biol Chem 2004; 279:48487.
Mantovani et al. Pentraxins in Innate Immunity: From C-Reactive Protein to the Long Pentraxin PTX3. J Clin Immunol (2008) 28:1–13.
Woloshin S, Schwartz LM. Distribution of C-reactive protein values in the United States. N Engl J Med 2005; 352:1611.
Ridker PM. Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation 2003; 107:363
Roberts WL, Moulton L, Law TC, et al. Evaluation of nine automated high-sensitivity C-reactive protein methods: implications for clinical and epidemiological applications. Part 2. Clin Chem 2001; 47:418.
Pearson TA, Mensah GA, Alexander RW, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003; 107:499.
Bogaty P, Brophy JM, Boyer L, Simard S, Joseph L, Bertrand F, Dagenais GR. Fluctuating inflammatory markers in patients with stable ischemic heart disease. Arch Intern Med. 2005 Jan 24;165(2):221-6.
Wilson PW, Pencina M, Jacques P, et al. C-reactive protein and reclassification of cardiovascular risk in the Framingham Heart Study. Circ Cardiovasc Qual Outcomes 2008; 1:92.
Kanwar M, Hashem M, Rosman H, et al. Usefulness of clinical evaluation, troponins, and C-reactive protein in predicting mortality among stable hemodialysis patients. Am J Cardiol 2006; 98:1283.
Ross R: Atherosclerosis: an inflammatory disease. N Engl J Med 340:115–126, 1999
Yeh ETH, Palusinski RP: C-reactive protein: the pawn has been promoted to queen. Curr Atheroscler Rep 5:101 -105, 2003
Heribert Schunkert, M.D., and Nilesh J. Samani, M.D., F.Med.Sci. Elevated C-Reactive Protein in Atherosclerosis — Chicken or Egg? N Engl J Med 2008; 359:1953-1955.
Rutter MK, Meigs JB, Sullivan LM, et al. C-reactive protein, the metabolic syndrome, and prediction of cardiovascular events in the Framingham Offspring Study. Circulation 2004; 110:380.
Ridker PM, et al. C-Reactive Protein Levels and Outcomes after Statin Therapy. N Engl J Med 2005;352:20-8.
Koenig, MD; C-Reactive Protein Modulates Risk Prediction Based on the Framingham Score Implications for Future Risk Assessment: Results from a Large Cohort Study in Southern Germany. Circulation. 2004;109:1349-1353.
Ridker PM C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14 719 initially healthy American women. Circulation. 2003 Jan 28;107(3):391-7.
Möhlenkamp S, Lehmann N, Moebus S, et al. Quantification of coronary atherosclerosis and inflammation to predict coronary events and all-cause mortality. J Am Coll Cardiol 2011; 57:1455-1464.
Buckley DI, Fu R, Freeman M, et al. C-reactive protein as a risk factor for coronary heart disease: a systematic review and meta-analyses for the U.S. Preventive Services Task Force. Ann Intern Med 2009; 151:483.
Kaptoge S, Di Angelantonio E, et al. Emerging Risk Factors Collaboration, C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis. Lancet 2010; 375:132.
Miller M, Zhan M, Havas S. High attributable risk of elevated C-reactive protein level to conventional coronary heart disease risk factors: the Third National Health and Nutrition Examination Survey. Arch Intern Med 2005; 165:2063.
Al-Delaimy WK, Merchant AT, Rimm EB, et al. Effect of type 2 diabetes and its duration on the risk of peripheral arterial disease among men. Am J Med 2004; 116:236.
Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364:937.
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Festa A, D’Agostino R Jr, Howard G, Mykkänan L, Tracy RP: Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS). Circulation 102:42–47, 2000
Kannel WB, McGee DL. Diabetes and cardiovascular risk factors: the Framingham study. Circulation 1979; 59:8.
Bulugahapitiya U, Siyambalapitiya S, Sithole J, Idris I. Is diabetes a coronary risk equivalent? Systematic review and meta-analysis. Diabet Med. 2009 Feb;26(2):142-8.
Danesh J, Wheeler JG, Hirschfield GM, et al. C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. N Engl J Med 2004; 350:1387.
Verma S,Wang C-H, Li S-H, Dumont AS, Fedak PWM, Badiwala MV, Dhillon B,Weisel RD, Li R-K, Mickle DAG, Stewart DJ: A self-fulfilling prophecy: C-reactive protein attenuates nitric oxide production and inhibits angiogenesis. Circulation 106:913–919, 2002
Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation. 2001;104: 2746-2753.
Schargrodsky et al, The CARMELA Study Assessment of Cardiovascular Risk in Seven Latin American Cities The American Journal of Medicine (2008)121, 58-65
Ordunez P, Silva LC, Rodriguez MP, Robles S. Prevalence estimates for hypertension in Latin America and the Caribbean: are they useful for surveillance? Rev Panam Salud Publica. 2001;10:226-231.
Mankowska A, Pollak J, Sypniewska G. Association of C-reactive protein and other markers of inflammation with risk of complications in diabetic subjects .Disponíble en: http://www.ifcc.org/ejifcc/vol17no1/17010320063.htm 2006.
Cipollone F, Iezzi A, Fazia M, Zucchelli M, Pini B, Cuccurullo C, De Cesare D, De Blasis G, Muraro R, Bei R, Chiarelli F, Schmidt AM, Cuccurullo F, Mezzetti A: The receptor RAGE as a progression factor amplifying arachidonatedependent inflammatory and proteolytic response in human atherosclerotic plaques: role of glycemic control. Circulation 108:1070–1077, 2003
Hitman, G. A. et al for the CARDS Investigators. Stroke prediction and stroke prevention with atorvastatin in the collaborative Atorvastatin Diabetes Study (CARDS). Diabet. Med. 24, 1313-1321 (2007).
World Health Organization. Prevalence of Diabetes worldwide. 2011
Coggins M, Lindner J, Rattigan S, et al. Physiologic hyperinsulinemia enhances human skeletal muscle perfusion by capillary recruitment. Diabetes 2001;50(12):2682–90.
Principales Causas de Mortalidad General, Anuario de Estadísticas vitales: Nacimientos y Defunciones- INEC 2019, en www.inec.gov.ec
Melmed: Williams Textbook of Endocrinology, 12va ed., Copyright 2011, Saunders.
Bernd Stratmann, PhD, Research Director, Diethelm Tschoepe, MD, Dr h.c., Medical Director: Atherogenesis and atherothrombosis – focus on diabetes Mellitus. Best Practice & Research Clinical Endocrinology & Metabolism 23 (2009) 291–303
Charles T. Valmadrid, MD, MPH; Ronald Klein, MD, MPH; Scot E. Moss, MA; Barbara E. K. Klein, MD, MPH: The Risk of Cardiovascular Disease MortalityAssociated with Microalbuminuria and Gross Proteinuria in Persons With Older-Onset Diabetes Mellitus. Arch Intern Med. 2000; 160:1093-1100
ACCORD Study Group, Cushman WC, Evans GW, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 2010; 362:1575
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38 BMJ 1998; 317:703–13
Bakris GL, Fonseca V, Katholi RE, et al. Metabolic effects of carvedilol vs metoprolol in patients with type 2 diabetes mellitus and hypertension: a randomized controlled trial. JAMA 2004; 292:2227.
Standards of Medical Care in Diabetes—2012, Diabetes Care, volume 34, supplement 1, january 2012
Hu FB, Stampfer MJ, Haffner SM, Solomon CG, Willett WC, Manson JF. Elevated risk of cardiovascular disease prior to clinical diagnosis of type 2 diabetes. Diabetes Care. 2002; 25:1129 –1134.
Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998; 352:837.
The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med 1993; 329:977.
D'Agostino RB Sr, Vasan RS, Pencina MJ, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 2008; 117:743.
Langer RD, Pradhan AD, Lewis CE, et al. Baseline associations between postmenopausal hormone therapy and inflammatory, haemostatic, and lipid biomarkers of coronary heart disease. The Women's Health Initiative Observational Study. Thromb Haemost 2005; 93:1108.
Rutter MK, Meigs JB, Sullivan LM, et al. C-reactive protein, the metabolic syndrome, and prediction of cardiovascular events in the Framingham Offspring Study. Circulation 2004; 110:380.
Rafaella C.P. Luna, Christiane C.C. do Nascimento, Relation between glucose levels, high-sensitivity C-reactive protein (hs-CRP), body mass index (BMI) and serum and dietary retinol in elderly in population-based study Archives of Gerontology and Geriatrics Volume 54, Issue 3, May–June 2012, Pages 462–468.
Yudkin, J.S.; Stehouwer, C.D.A.; Emeis, J.J.; Coppack, S.W. C-reactive protein in healthy subjects: Associations with obesity, insulin resistance and endothelial dysfunction: a potential role for cytokines originating from adipose tissue. Int. J. Obes. 1999, 19, 972-978.
Santos, A.C.; Lopes, C.; Guimaraes, J.T.; Barros, H. Central obesity as a major determinant of increased high-sensitivity C-reactive protein in metabolic syndrome. Int. J. Obes. 2005, 29, 1452-1456.
Amit Khera, Darren K. McGuire, Sabina A. Murphy, Harold G. Stanek, Sandeep R. Das, Wanpen Vongpatanasin, Frank H. Wians, Scott M. Grundy, James A. de Lemos. Race and Gender Differences in C-Reactive Protein Levels. Journal of the American College of Cardiology Vol. 46, No. 3, 2005.
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Publicado
2024-11-17
Cómo citar
1.
Proaño Angulo RC. Correlación entre niveles séricos de PCR ultrasensible y factores de riesgo cardiovasculares en pacientes adultos con Diabetes Mellitus tipo 2. PFR [Internet]. 17 de noviembre de 2024 [citado 15 de diciembre de 2024];9(3). Disponible en: https://practicafamiliarrural.org/index.php/pfr/article/view/332
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