Abstract
Background:
Cardiovascular disease is the primary cause of mortality among individuals with type 2 diabetes mellitus (T2DM). Among its complications, acute myocardial infarction (AMI) represents one of the most life-threatening events, contributing considerably to both death and long-term disability. Increasing evidence suggests that persistent low-grade inflammation plays a crucial role in atherosclerotic plaque formation and rupture. Biomarkers of systemic inflammation, particularly high-sensitivity C-reactive protein (hs-CRP) and selected interleukins, have been investigated as possible predictors of cardiovascular events. Nevertheless, data from regional populations in Pakistan, especially Southeastern Punjab, remain limited.
Objective:
This study aimed to determine whether baseline levels of specific inflammatory markers—C-reactive protein and selected interleukins—are associated with the future development of acute myocardial infarction in patients diagnosed with type 2 diabetes.
Methods:
A prospective cohort investigation was carried out at a tertiary care hospital in Southeastern Punjab, Pakistan, between January 2023 and December 2024. The study enrolled 450 adults aged 35 to 75 years with confirmed T2DM through consecutive sampling. Individuals with a history of myocardial infarction, documented coronary artery disease, chronic inflammatory disorders, malignancy, or advanced hepatic or renal impairment were excluded. At enrollment, demographic and clinical information was recorded, and fasting blood samples were obtained to measure hs-CRP, interleukin-6 (IL-6), interleukin-1 beta (IL-1β), lipid profile components, and glycemic parameters. Participants were followed for 24 months to identify first-time AMI events, confirmed by clinical symptoms, electrocardiographic findings, and elevated cardiac troponin levels. Cox proportional hazards models were applied to evaluate the relationship between inflammatory markers and incident AMI, with adjustment for conventional cardiovascular risk factors.
Results:
Over the two-year follow-up period, 58 participants (12.9%) experienced an acute myocardial infarction. Patients who developed AMI had significantly higher baseline hs-CRP levels compared with those who did not experience cardiac events. IL-6 concentrations were moderately elevated among affected individuals, whereas IL-1β showed no meaningful difference between groups. After adjusting for potential confounders—including age, gender, hypertension, smoking, lipid levels, body mass index, and diabetes duration—hs-CRP remained independently associated with increased AMI risk. A dose-response relationship was observed, with progressively higher hs-CRP levels corresponding to greater risk.
Conclusion:
Baseline elevation of hs-CRP is strongly associated with the occurrence of acute myocardial infarction in individuals with type 2 diabetes. These findings reinforce the contribution of inflammatory pathways to cardiovascular risk in this population. Routine measurement of hs-CRP may enhance risk stratification and facilitate earlier preventive interventions in high-risk diabetic patients.