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Serum C peptide and carotid intima-medial thickness are independent markers of glucose intolerance among patients with ischemic cerebrovascular stroke
The Egyptian Journal of Internal Medicine volume 31, pages 368–375 (2019)
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Abstract
Background
Stroke is the most common cause of disability worldwide. C-peptide is co-secreted with insulin from beta cells of the pancreas, thus providing a better index of endogenous insulin production and pancreatic beta cell function. The objective of the current study was to explore serum C-peptide and carotid intimamedia thickness in patients with ischemic stroke (IS) and to assess the association of serum C-peptide with vascular and metabolic risks.
Patients and methods
The case–control study included 50 healthy control and 150 patients with IS who were stratified into three subgroups according to their fasting plasma glucose, normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and type 2 diabetes mellitus (T2DM). All the participants were subjected to B-mode ultrasonography of both common carotid arteries to measure carotid intimamedia thickness (mm). Serum C peptide concentration was measured by enzyme-linked immunosorbent assay.
Results
Serum C peptide levels were higher in IS patients compared with control. Among the IS patients, C peptide was higher in T2DM compared with IGT and NGT and is associated with vascular and metabolic risks, after adjusting for the traditional risk factors. C-peptide was a statistically significance predictor of T2DM among IS patients by the logistic regression analysis test. In addition, homeostasis model assessment of insulin resistance (HOMA-IR), fasting plasma glucose, BMI, and fat mass index (FMI)% were independently correlated with C-peptide by. The diagnostic value of C-peptide by receiver operating characteristic curves was highly significant; the sensitivities and the specificities were 96 and 98%.
Conclusion
Serum peptide levels were higher in IS patients compared with the control. Among the IS patients, serum C peptide was higher in T2DM compared with IGT and NGT and is associated with vascular and metabolic risks.
References
Bunevicius A, Iervasi G, Bunevicius R, Appel LJ, Braun LT, Chaturvedi S et al. Neuroprotective actions of thyroid hormones and low-T3 syndrome as a biomarker in acute cerebrovascular disorders. Expert Rev Neurother 2015; 15: 315–326.
Goldstein LB, Bushnell CD, Adams RJ et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42: 517–584.
Adler AI, Stevens RJ, Neil A, Stratton IM, Boulton AJM, Holman RR. UKPDS 59: Hyperglycemia b and other potentially modifiable risk factors for peripheral vascular disease in type 2 diabetes. Diabetes Care 2002; 25: 894–899.
International Diabetes Federation Diabetes Atlas. Diabetes care (2nd ed.). International Diabetes Federation: Brussels. 2003.
Held C, Hjemdahl P, Eriksson SV, Björkander I, Forslund L, Rehngvist N. Prognostic implications of intima-media thickness and plaques in the carotid and femoral arteries in patients with stable angina pectoris. Eur Heart J 2001; 22: 62–72.
Acevedo M, Krämer V, Tagle R, Arnaiz P, Corbalán R, BerrÃos X et al. Cardiovascular risk factors among young subjects with high carotid intima-media thickness. Rev Med Chil 2011; 139: 1322–1329.
Ferranini E, Cobelli C. The kinetics of insulin in man. Role Liver Diabetes Metab Rev 1987; 3: 365–397.
Ashby TD, Frier BM. Circulating c-peptide measurement and clinical application. Annals Clin Biochem 1981; 18: 125.
Castillo J, Davalos A, Noya M. Progression of ischaemic stroke and excitotoxic amino acids. Lancet 1997; 349: 79–83.
Frieldewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without the use of the preparative ultracentrifuge. Clin Chem 1972; 18: 499–502.
Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV et al. A randomized trial of intensive versus standard blood pressure control. N Engl J Med 2015; 373:2103–2116.
Tardif JC, Heinonen T, Orloff D, Libby P. Vascular biomarkers and surrogates in cardiovascular disease. Circulation 2006; 113: 2936–2942.
Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with carotid intima‐media thickness: a systematic review and meta‐analysis. Circulation 2007; 115: 459–467.
De Groot E, van Leuven SI, Duivenvoorden R, Meuwese MC, Akdim F et al. Measurement of carotid intima‐media thickness to assess the progression and regression of atherosclerosis. Nat Clin Pract Cardiovasc Med 2008; 5: 280–288.
Lorenz MW, Polak JF, Kavousi M, Mathiesen EB, Volzke H, Bots ML et al. PROG‐IMT Study Group. Carotid intima‐media thickness progression to predict cardiovascular events in the general population (the PROG‐IMT collaborative project): a meta‐analysis of individual participant data. Lancet 2012; 379: 2053–2062.
Lorenz MW, Gao L, Ziegelbauer K, Norata GD, Empana JP, Schmidtmann XX et al. Predictive value for cardiovascular events of common carotid intima media thickness and its rate of change in individuals at high cardiovascular risk — Results from the PROG-IMT collaboration. PLoS One 2018; 13: e0191172.
Li Y, Meng L, Li Y, Sato Y. Associations of serum C-Peptide level with body fat distribution and ever stroke in nondiabetic subjects. J Stroke Cerebrovasc Dis 2014; 23: e163–e169.
Hirai FE, Moss SE, Klein BE et al. Relationship of glycemic control, exogenous insulin, and C-peptide levels to ischemic heart disease mortality over a 16-year period in people with older-onset diabetes: the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR). Diabetes Care 2008; 31: 493–497.
Marx N, Silbernagel G, Brandenburg V et al. C-peptide levels are associated with mortality and cardiovascular mortality in patients undergoing angiography: the LURIC Study. Diabetes Care 2013; 36: 708–714.
Walcher D, Aleksic M, Jerg V, Burgmaier M, Kleber M, Grammer T et al. C-peptide induces chemotaxis of human CD4-positive cells: involvement of pertussis toxin-sensitive G-proteins and phosphoinositide 3-kinase. Diabetes 2004; 53: 1664–1670.
Marx N, Walcher D, Raichle C, Aleksic M, Bach H, Grüb M et al. C-peptide colocalizes with macrophages in early arteriosclerotic lesions of diabetic subjects and induces monocyte chemotaxis in vitro. Arterioscler Thromb Vasc Biol 2004; 24: 540–545.
Walcher D, Babiak C, Poletek P, Hombach V, Zieske A, Homma S et al. C-Peptide induces vascular smooth muscle cell proliferation: involvement of SRC-kinase, phosphatidylinositol 3-kinase, and extracellular signal-regulated kinase 1/2. Circ Res 2006; 99: 1181–1187.
Haban P, Simoncic R, Zidekova E, Ozdin L. Role of fasting serum C-peptide as a predictor of cardiovascular risk associated with the metabolic X-syndrome. Med Sci Monit 2002; 8: CR175–CR179.
Kim ST, Kim BJ, Lim DM, Song I, Jung J, Lee K et al. Basal C-peptide level as a surrogate marker of subclinical atherosclerosis in type 2 diabetic patients. Diabetes Metab J 2011; 35: 41–49.
Wang L, Lin P, Ma A, Zheng H, Wang K, Li W et al. C-peptide is independently associated with an increased risk of coronary artery disease in T2DM subjects: a cross-sectional study. PLoS One 2015; 10: e0127112.
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Rashad, N.M., Samir, G.M., Sabry, H.M. et al. Serum C peptide and carotid intima-medial thickness are independent markers of glucose intolerance among patients with ischemic cerebrovascular stroke. Egypt J Intern Med 31, 368–375 (2019). https://doi.org/10.4103/ejim.ejim_97_18
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DOI: https://doi.org/10.4103/ejim.ejim_97_18