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

Abstract

BackgroundCoronary 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.MethodsThree 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 ≥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.ResultsSerum 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%).ConclusionSerum 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.

Glycated Albumin Is Superior to Hemoglobin A_1c for Evaluating the Presence and Severity of Coronary Artery Disease in Type 2 Diabetic Patients

“…Although the classification of significant CAD as angiographic percent stenosis ≥70% at the site of coronary artery lesions in our study is to some extent arbitrary, this criterion of stenosis severity has been correlated with physiologic significance, has relevance to commonly applied angiographic standards and is widely accepted clinical practice [19]. Consistent with previous reports [6,7], we also show that measurement of serum GA levels was able to ascertain the disparity in the same batch of patients; those with diabetes and higher serum GA levels were more prone to develop severe coronary disease. A GA ≥20% was associated with a 2.69-fold increase in relative risk for significant CAD.…”

“…Glycated hemoglobin A 1c (HbA 1c ) has been widely recognized as a marker of glycemic control [3] and was used to estimate the degree of coronary artery disease (CAD) and the risk of major adverse cardiac events (MACE) after successful implantation of drug-eluting stents in patients with type 2 diabetes mellitus (T2DM) [4,5]. Glycated albumin (GA) accounts for almost 80% of the circulating glycated proteins in vivo and is related to the development and progression of vascular complications in diabetes [6,7,8,9]. Although both serum GA level and blood HbA 1c concentration are closely associated with systemic inflammation and increase the likelihood of atherosclerosis [10,11], it remains unclear whether they are equally important indicators of severe coronary disease for patients with T2DM.…”

Association of increased serum glycated albumin levels with low coronary collateralization in type 2 diabetic patients with stable angina and chronic total occlusion

“…The linear range for this assay was 3.2-68.1% and the maximum inter-assay coefficient of variation (CV) was < 3.0% [11,12,14]. …”

Efficacy and Safety of Ezetimibe in Combination with Atorvastatin for Acute Coronary Syndrome Patients Accompanied with Type 2 Diabetes: A Single-Center, Non-randomized Cohort Study

“…These results are supported by previous studies in Chinese populations. [18][19][20] These findings suggest that the combined use of EZ plus atorvastatin resulted in higher lipid-lowering effects than using atorvastatin alone. This could be associated with the restriction of the "cholesterol escape" observed when using statins alone.…”

“…These results are supported by previous studies in Chinese populations. [18][19][20] Studies have demonstrated that the coronary artery lesions in patients with ACS and T2DM are more severe than those in patients without T2DM, leading to poorer prognosis. 21) Therefore, aggressive lipid-lowering treatment is recommended for patients with T2DM to control their LDL-C levels.…”