The impact of metabolic syndrome and CRP on vascular phenotype in type 2 diabetes mellitus

Eur J Intern Med. 2008 Mar;19(2):115-21. doi: 10.1016/j.ejim.2007.06.011. Epub 2007 Nov 5.


Background: The burden of cardiovascular disease in diabetes mellitus type 2 (DM2) patients is variable. We hypothesize that metabolic syndrome (MS) and low-grade systemic inflammation modify the extent of atherosclerosis in DM2.

Methods: Vascular phenotype was determined using the following endothelium-related, hemostatic, and sonographic endpoints in 62 DM2 patients with mild dyslipidemia: sVCAM, sE-selectin, von Willebrand factor (VWF), fibrinogen, s-thrombomodulin (sTM), tPA, PAI-1, flow-mediated dilation (FMD), and intima media thickness (IMT). The impact of MS load (number of criteria present), MS components, and CRP on these parameters was assessed.

Results: Serum sVCAM, sTM, and tPA levels significantly increased with increasing MS load. IMT also significantly increased from 0.602+/-0.034 (one MS criterion) to 0.843+/-0.145 (four MS criteria, p=0.007). LogCRP significantly correlated with fibrinogen, PAI-1, and IMT. In a multiple regression (MR) model with age and gender as covariates, MS load predicted sVCAM and sTM; CRP predicted PAI-1 and fibrinogen; MS load and CRP simultaneously predicted tPA and IMT. For each MS criterion present, IMT significantly increased by 0.04 mm. An increase in CRP from 1 to 3 mg/L resulted in a significant increase of 0.04 mm. Patients with four MS criteria and inflammation (CRP >or=3 mg/L) are predicted to have a 0.21 mm thicker IMT than those without. A second stepwise MR analysis based on gender, traditional risk factors, diabetes-related parameters, renal function, individual MS criteria, and LogCRP as explanatory variables showed a significant effect of systolic and diastolic blood pressure, HDL, and LogCRP on IMT(r(2)=0.36, p<0.001).

Conclusion: MS and low-grade chronic inflammation have an independent impact on vascular phenotype including IMT in DM2.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Biomarkers / blood
  • C-Reactive Protein / analysis*
  • Diabetes Mellitus, Type 2 / physiopathology*
  • E-Selectin / blood
  • Female
  • Fibrinogen / analysis
  • Humans
  • Inflammation
  • Male
  • Metabolic Syndrome / physiopathology*
  • Middle Aged
  • Phenotype
  • Plasminogen Activator Inhibitor 1 / blood
  • Thrombomodulin / blood
  • Tissue Plasminogen Activator
  • Tunica Intima / pathology
  • Tunica Media / pathology
  • Vascular Cell Adhesion Molecule-1 / blood
  • von Willebrand Factor / analysis


  • Biomarkers
  • E-Selectin
  • Plasminogen Activator Inhibitor 1
  • Thrombomodulin
  • Vascular Cell Adhesion Molecule-1
  • von Willebrand Factor
  • Fibrinogen
  • C-Reactive Protein
  • Tissue Plasminogen Activator