Various biomarkers indicate immune activation in type 2 diabetes and atherosclerosis, and some of these inflammatory markers including C-reactive protein have been shown to predict the incidence of cardiovascular events (1) and diabetes (2).

The vessel wall and adipose tissue are both sources of pro-inflammatory mediators. Experimental evidence further supports a pathogenic role of immune mediators in type 2 diabetes (3-5).

The adipocytokine adiponectin has several potential anti-inflammatory and anti-atherogenic effects (6). Increased levels of adiponectin have been associated with decreased risk of coronary events in the Health Professionals Follow-up Study (7). The EPIC Study (8) and the ARIC Study (9) further showed an inverse relationship between adiponectin levels and incidence of type 2 diabetes.

Lifestyle changes (10, 11) and medications (12) have been shown to have anti-inflammatory effects.

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After viewing this presentation the participant will be able to discuss:

- Studies relating to inflammatory biomarkers in the prediction of risk for CHD events and diabetes
- The effects of adiponectin
- Lifestyle modifications and medications which may have an anti-inflammatory effect

1. Paul M Ridker, MD.Clinical Application of C-Reactive Protein for Cardiovascular Disease Detection and Prevention Circulation. 2003;107:363.

2. Andreas Festa, Ralph D’Agostino, Jr, Russell P. Tracy, and Steven M. Haffner.Elevated Levels of Acute-Phase Proteins and Plasminogen Activator Inhibitor-1 Predict the Development of Type 2 Diabetes: The Insulin Resistance Atherosclerosis Study Diabetes.2002;51:1131-1137.

3. Zhao Ming Dong, Jose-Carlos Gutierrez-Ramos, Angela Coxon, Tanya N. Mayadas, and Denisa D. Wagner.A new class of obesity genes encodes leukocyte adhesion receptorsProc. Natl. Acad. Sci. USA.1997;Vol. 94, pp. 7526-7530.

4. Ville Wallenius, Kristina Wallenius, Bo Ahrén, Mats Rudling, Hans Carlsten, Suzanne L. Dickson, Claes Ohlsson & John-Olov Jansson.Interleukin-6-deficient mice develop mature-onset obesityNat.Med.2002;8(1):75-79.

5. Li-Jun Ma, Su-Li Mao, Kevin L. Taylor, Talerngsak Kanjanabuch, YouFei Guan, YaHua Zhang, Nancy J. Brown, Larry L. Swift, Owen P. McGuinness, David H. Wasserman, Douglas E. Vaughan, and Agnes B. Fogo.Prevention of Obesity and Insulin Resistance in Mice Lacking Plasminogen Activator Inhibitor 1Diabetes.2004;53:336-346.

6. Kazunori Shimada,Tetsuro Miyazaki and Hiroyuki Daida. Adiponectin and atherosclerotic disease Clinica Chimica Acta 2004;344:1-12.

7. Tobias Pischon, MD, MPH; Cynthia J. Girman, DrPH; Gokhan S. Hotamisligil, MD, PhD; Nader Rifai, PhD; Frank B. Hu, MD, PhD; Eric B. Rimm, ScD. Plasma Adiponectin Levels and Risk of Myocardial Infarction in Men JAMA. 2004;291:1730-1737.

8. Joachim Spranger, Anja Krokec, Matthias Möhliga, Manuela M Bergmann, Michael Ristow, Heiner Boeing and Andreas F H Pfeiffer.Adiponectin and protection against type 2 diabetes mellitus The Lancet.2003;361(9353):226.

9. Bruce B. Duncan, Maria Inês Schmidt, James S. Pankow, Heejung Bang, David Couper, Christie M. Ballantyne, Ron C. Hoogeveen, and Gerardo HeissAdiponectin and the Development of Type 2 Diabetes: The Atherosclerosis Risk in Communities StudyDiabetes.2004;53:2473-2478.

10. J. Kelly Smith, MD; Rhesa Dykes, BS; John E. Douglas, MD; Guha Krishnaswamy, MD; Steven Berk, MD. Long-term Exercise and Atherogenic Activity of Blood Mononuclear Cells in Persons at Risk of Developing Ischemic Heart Disease JAMA. 1999;281:1722-1727.

11. Dietrich Rothenbacher, MD, MPH; Albrecht Hoffmeister, MD; Hermann Brenner, MD, MPH; Wolfgang Koenig, MD.
Physical Activity, Coronary Heart Disease, and Inflammatory Response Arch Intern Med. 2003;163:1200-1205.

12. Giuseppe G. L. Biondi-Zoccai MD, Antonio Abbate MD, Giovanna Liuzzo MD and Luigi M. Biasucci MD, FACC.Atherothrombosis, inflammation, and diabetes JACC.2003;41(7):1071-1077.