 |
|
 |
- May 14, 2008 |
|
|
Welcome to the #1 online source of information for Diabetes Specialists! An international online community of more than 10,000 Diabetes Specialists.
CME on Diabetes is a website built to transmit top-level CME conferences given by international experts in endocrinology, insulin resistance, prediabetes, metabolic syndrome and type 2 diabetes. More than 2.6 million slides have been viewed since the website launch. Thank you for your continued support and commitment!
|
|
|
| Presentation |
|
"CRP, Inflammation, and its Relationship to Cardiovascular Disease, Metabolic Syndrome and Type 2 Diabetes"Dr. Paul M. Ridker (biography)
English - 2004-06-25 - 45 minutes
|
 | (42 slides) |
Summary :
In this presentation Dr Ridker reviews the use of high-sensitivity C-Reactive Protein (hs-CRP) as a prognostic indicator of myocardial infarction, stroke and type 2 diabetes; the added prognostic information CRP provides in patients with the metabolic syndrome, the role of CRP in atherothrombosis, and how some antidiabetic agents have been shown to lower levels of inflammatory markers including CRP.
The Physician's Health Study and the Women's Health Study were large-scale studies showing hs-CRP levels to be a risk predictor of first ever myocardial infarction or stroke in men (1) and cardiovascular events in women (2). Another large study in women showed CRP to have a stronger predictive value than LDL-C for first ever cardiovascular events (3), and that screening for both CRP and lipids provided better prognostic information than either one alone (3). CRP was also found to be predictive of future cardiovascular events in patients with the metabolic sydrome and to add prognostic information to the ATP-III definition of the metabolic sydrome (4).
In a cross-sectional study by Yudkin et al, CRP levels were found to be related to insulin resistance, obesity and endothelial dysfunction (5). Data derived from the Women's Health Study furthermore showed elevated levels of CRP to predict the development of type 2 diabetes (6). This was confirmed by data from the Nurses' Health Study (7). The antidiabetic thiazolidinedione drug rosiglitazone has been shown to lower CRP levels (8) and CD40L (9) in patients with type 2 diabetes. Pioglitazone also lowers CRP (10), making this most likely a class effect. The thiazolidinediones are PPAR gamma agonists, however the PPAR alpha agonist fenofibrate has also been shown to lower CRP levels (11).
CRP levels have also been associated with future development of hypertension (12), and are known to play a direct role in atherosclerosis (13, 14) and thrombosis (15).
Copyright © 2004 E-MedHosting.com Inc
Learning objectives :
The participant will learn about CRP in relation to CVD, metabolic syndrome and type 2 diabetes.
Bibliographic references :
1. Paul M. Ridker, M.D., Mary Cushman, M.D., Meir J. Stampfer, M.D., Russell P.Tracy, Ph.D., and Charles H. Hennekens, M.D. Inflammation, Aspirin, and the Risk of Cardiovascular Disease in Apparently Healthy Men. NEJM 1997;336:973-79.
2. Paul M. Ridker, M.D., Charles H. Hennekens, M.D., Julie E. Buring, Sc.D., and Nader Rifai, Ph.D. C-Reactive Protein and Other Markers of Inflammation in the Prediction of Cardiovascular Disease in Women NEJM 2000;342:836-43.
3. Paul M. Ridker, M.D., Nader Rifai, Ph.D., Lynda Rose, M.S., Julie E. Buring, Sc.D., and Nancy R. Cook, Sc.D. Comparison of C-Reactive Protein and Low-Density Lipoprotein Cholesterol Levels in the Prediction of First Cardiovascular Events NEJM 2002;347: 1557-65.
4. Paul M Ridker, MD; Julie E. Buring, ScD; Nancy R. Cook, ScD; Nader Rifai, PhD C-Reactive Protein, the Metabolic Syndrome, and Risk of Incident Cardiovascular Events Circulation 2003;107: 391-7.
5. John S. Yudkin; C. D. A. Stehouwer; J. J. Emeis; S. W. Coppack C-Reactive Protein in Healthy Subjects: Associations With Obesity, Insulin Resistance, and Endothelial Dysfunction ATVG 1999;19:972-978 .
6. Aruna D. Pradhan, MD,MPH; JoAnn E. Manson, MD,DrPH; Nader Rifai, PhD; Julie E. Buring, ScD; Paul M. Ridker, MD,MPH C-Reactive Protein, Interleukin 6, and Risk of Developing Type 2 Diabetes Mellitus JAMA. 2001;286:327-334.
7. Frank B. Hu, James B. Meigs, Tricia Y. Li1, Nader Rifai, and JoAnn E. Manson Inflammatory Markers and Risk of Developing Type 2 Diabetes in Women Diabetes 53:693-700,2004.
8. Steven M. Haffner, MD; Andrew S. Greenberg, MD; Wayde M. Weston, PhD; Hongzi Chen, PhD; Ken Williams, MS; Martin I. Freed, MD Effect of Rosiglitazone Treatment on Nontraditional Markers of Cardiovascular Disease in Patients With Type 2 Diabetes Mellitus Circulation.2002;106:679.
9. Nikolaus Marx, MD; Armin Imhof, MD; Johannes Froehlich, MS; Laila Siam, MS; Jochen Ittner, MD; Gerhard Wierse, MD; Arnold Schmidt, MD; Winfried Maerz, MD; Vinzenz Hombach, MD; Wolfgang Koenig, MD Effect of Rosiglitazone Treatment on Soluble CD40L in Patients With Type 2 Diabetes and Coronary Artery Disease Circulation. 2003;107:1954.
10. Noriko Satoh, MD, PHD, Yoshihiro Ogawa, MD, PHD, Takeshi Usui, MD, PHD, Tetsuya Tagami, MD, PHD, Shigeo Kono, MD, PHD, Hiroko Uesugi, MD, PHD, Hiroyuki Sugiyama, MD, PHD, Akira Sugawara, MD, PHD, Kazunori Yamada, MD, PHD, Akira Shimatsu, MD, PHD, Hideshi Kuzuya, MD, PHD and Kazuwa Nakao, MD, PHD. Antiatherogenic Effect of Pioglitazone in Type 2 Diabetic Patients Irrespective of the Responsiveness to Its Antidiabetic Effect Diabetes Care 26:2493-2499, 2003.
11. BART STAELS, WOLFGANG KOENIG, AÏDA HABIB, RÉGINE MERVAL, MARILYNE LEBRET, INÉS PINEDA TORRA, PHILIPPE DELERIVE, ABDESSAMAD FADEL, GIULIA CHINETTI, JEAN-CHARLES FRUCHART, JAMILA NAJIB, JACQUES MACLOUF & ALAIN TEDGUIActivation of human aortic smooth-muscle cells is inhibited by PPAR (alpha) but not by PPAR (gamma) activatorsNature 393, 790 - 793 (25 June 1998).
12. Howard D. Sesso, ScD, MPH; Julie E. Buring, ScD; Nader Rifai, PhD; Gavin J.Blake, MD, MPH; J. Michael Gaziano, MD, MPH; Paul M. Ridker, MD, MPH C-Reactive Protein and the Risk of Developing Hypertension JAMA. 2003;290:2945-2951.
13. Ridker PM; JUPITER Study Group. Rosuvastatin in the primary prevention of cardiovascular disease among patients with low levels of low-density lipoprotein cholesterol and elevated high-sensitivity C-reactive protein: rationale and design of the JUPITER trial
Circulation. 2003 Nov 11;108(19):2292-7.
14. Paul A, Ko KW, Li L, Yechoor V, McCrory MA, Szalai AJ, Chan L. C-reactive protein accelerates the progression of atherosclerosis in apolipoprotein E-deficient mice. Circulation. 2004 Feb 10;109(5):647-55. Epub 2004 Jan 26.
15. Danenberg HD, Szalai AJ, Swaminathan RV, Peng L, Chen Z, Seifert P, Fay WP, Simon DI, Edelman ER. Increased thrombosis after arterial injury in human C-reactive protein-transgenic mice. Circulation. 2003 Aug 5;108(5):512-5. Epub 2003 Jul 21.
|
|
|
|
|
|
| Search our website |
 |
| |
Would you like to know more about insulin resistance? Are you looking for information pertaining to Type 2 Diabetes? You can find what you are looking for in over 2000 references available on CMEonDiabetes. |
| |
|
|
| Social |
|
| |
Let others know about this presentation.
|
|
|
|
