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C-peptide has bidirectional association with CV risk in nondiabetic and newly diagnosed diabetes patients
China: Research published in Cardiovascular Diabetology has suggested a bidirectional effect of C-peptide on cardiovascular (CV) risk in nondiabetic adults and patients newly diagnosed with type 2 diabetes. The study found that the association of C-peptide with cardiovascular biomarkers and events was different between people without previous T2D and those with previous T2D.
"The bidirectional effect of C-peptide on cardiovascular risk implies that it plays a beneficial role at a low level and may be harmful at a high level in patients with newly diagnosed T2D and nondiabetic adults," Fu-Sheng Fang, Chinese PLA General Hospital, Beijing, China, and colleagues wrote in their study.
Insulin and C-peptide are produced from a similar precursor and secreted in equimolar amounts into circulation. However, C-peptide is subjected to negligible hepatic first-pass metabolism, unlike insulin, has almost five to ten times higher half-life, and has been recognized as a surrogate marker of beta cell function in the pancreas.
C-peptide is reported to be a biologically active peptide and has been shown to reduce hyperglycemia-induced inflammation and provide protection against diabetic complications in diabetes mellitus. Also, C-peptide is seen as a therapeutic strategy for preventing diabetic vasculopathy in type 1 diabetes. Recent research has shown a positive correlation between C-peptide and arterial stiffness and cardiovascular death in nondiabetic patients. Increased C-peptide levels may play a causal role in early pathogenesis in T2D patients. Overall, the beneficial effects of C-peptide seem insignificant and negative in healthy people and T2D patients.
More studies are required to establish the role of C-peptide, particularly in nondiabetic adults and T2D patients, given the limited number of studies investigating the effects of C-peptide and the potential for confounding, like insulin levels. Considering this, the research team examined associations between fasting C-peptide and cardiovascular biomarkers and events in healthy people and T2D patients. Associations were also discussed, stratified by insulin resistance index and glucose metabolism status.
The study included a total of 55636 participants who had a health examination from 2017 to 2021, out of which 6727 patients visited the hospital at least twice. Measuring cardiovascular biomarkers like high-sensitivity cardiac troponin T (hs-cTnT) and high-sensitivity C-reactive protein (hs-CRP) was done, and their relationships with fasting C-peptide were investigated for all patients. During the last visit, cardiovascular events were obtained, and their associations with C-peptide were evaluated for patients who visited the hospital at least twice.
The study demonstrated the following findings:
· 11.1% had a previous type 2 diabetes (T2D).
· In the participants without previous T2D, the relation between fasting C-peptide and hs-CRP and hs-cTnT was negative in cases where the value of fasting C-peptide was < 1.4 ng/mL and positive if the value was ≥ 1.4 ng/mL.
· These relationships remained significant after adjustment for insulin resistance index, hemoglobin A1c, and its interaction with C-peptide.
· Hazard ratios of CV events first decreased and then increased with baseline C-peptide levels, though these associations became insignificant.
· The associations of C-peptide with cardiovascular biomarkers and events were insignificant in the patients with the previous T2DM, unlike the participants without previous T2DM.
"Further research is needed to examine the role of C-peptide, the mechanism behind the role, and the difference in this role in nondiabetic adults and T2D patients," the researchers concluded.
Reference:
Yan, ST., Sun, J., Gu, ZY. et al. The bidirectional association of C-peptide with cardiovascular risk in nondiabetic adults and patients with newly diagnosed type 2 diabetes mellitus: a retrospective cohort study. Cardiovasc Diabetol 21, 201 (2022). https://doi.org/10.1186/s12933-022-01636-z
MSc. Biotechnology
Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at  editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751