Abstract 8687: C-peptide Levels Predict Cardiovascular And Diabetes Related Mortality In Non-diabetic Adults
Objective: Insulin resistance (IR), characterized by high endogenous insulin levels with or without clinical diabetes mellitus (DM), is an established pathophysiological precursor to the development of cardiovascular disease (CVD). Since IR can be intervened upon and endogenous insulin production is best measured by c-peptide levels, we sought to evaluate whether c-peptide levels can predict future CVD and DM related mortality before the onset of DM.
Methods: US adults 40-74 years of age without clinical DM were identified based on a negative history, glucose tolerance test, fasting glucose or glycated hemoglobin levels from the III National Health and Nutrition Examination Survey (1988-1994) and followed through 12/31/2006. Vital status was obtained via linkage with the National Death Index and ICD-10 for causes of death. Participants were stratified by their degree of IR as measured by quartiles of fasting c-peptide levels and weighted analysis conducted to compare their cumulative risk of CVD and/or DM related mortality using lowest c-peptide quartile as the referent. Cox proportional hazard ratios (HR) adjusted for potential confounding. Analyses were repeated in subgroups of low CVD risk.
Results: We identified 5,124 subjects, representative of 61,594,485 US adults without DM, mean age 54.9 ± 10.5, 48.4% male, 81.8% of Caucasian race. Quartiles of c-peptide levels were significantly associated with both CVD and DM death separately, and combined (table). Subgroup analyses suggested that c-peptide levels further stratified combined CVD/DM death risk in patients with traditionally low CVD/DM risk (ldl <130mg/dl, normal glucose, BMI <25kg/m2, BP<140/90 mmHg).
Conclusion: C-peptide levels predict CVD and DM related death in non-diabetic adults beyond traditional CVD/DM risk factors and may be a useful biomarker to identify otherwise unrecognized high risk subjects with significant IR for early intervention.
- © 2011 by American Heart Association, Inc.