The association of high-sensitivity C-reactive protein levels and their changes with heart failure in Chinese diabetes patients

To investigate the associations of baseline high-sensitivity C-reactive protein (hs-CRP), hs-CRP trajectories, and cumulative hs-CRP (CumCRP) exposure with the risk of incident heart failure (HF) in individuals with diabetes.

We analyzed 18,269 patients with diabetes from the Kailuan Study who were free of HF and cancer at baseline (2006–2012). Baseline hs-CRP was categorized into quartiles (Q1-Q4), with a separate group for hs-CRP values > 20 mg/L. Repeated measurements were used to identify long-term trajectories via group-based trajectory modelling and calculate time-weighted cumulative hs-CRP after excluding participants with hs-CRP > 20 mg/L. Fine-Gray subdistribution hazard models were employed to estimate adjusted hazard ratios (HRs) for incident HF.

Over a mean follow-up of 9.66 ± 2.85 years, 826 HF occurred. Compared with baseline hs-CRP quartile (Q1), the HRs for HF increased across higher quartiles and in the > 20 mg/L group were 1.22 (95% CI 0.98–1.52) for Q2, 1.25 (1.00-1.55) for Q3, 1.42 (1.15–1.76) for Q4, and 1.68 (1.24–2.28) for hs-CRP > 20 mg/L group. In longitudinal analyses, the high-decreased (HR:1.65; 95% CI:1.32–2.06) and moderate-fluctuated (HR:1.48; 95% CI:1.07–2.04) trajectories were associated with significantly higher HF risk than the low-stable pattern. Similarly, the highest CumCRP quartiles were associated with increased HF risk with HR (95% CI) of 1.33 (1.08–1.64) for Q3, and 1.47 (1.19–1.82) for Q4 compared to Q1.

In this large cohort of patients with diabetes, higher baseline hs-CRP, greater cumulative hs-CRP exposure, and hs-CRP trajectories characterized by earlier elevation were independently associated with increased risk of incident HF. These findings highlight the importance of monitoring long-term inflammatory burden for HF risk stratification in diabetes.