Comparing the Levels of Acute-Phase Reactants Between Smoker and Nonsmoker Diabetic Patients: More Predicted Risk for Cardiovascular Diseases in Smoker Compared to Nonsmoker Diabetics

  • Sepideh Rezaei-Adl Department of Biology, School of Sciences, Islamic Azad University, Tehran, Iran.
  • Arash Ghahroudi Tali Department of Biology, School of Sciences, Islamic Azad University, Tehran, Iran.
  • Hiva Saffar Department of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Afsaneh Rajabiani Department of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Alireza Abdollahi Department of Pathology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Keywords: Acute-phase reactants, Diabetic patients, Cardiovascular diseases


 Due to a close link between cardiovascular disorders and increased acute phase responses, it is now proposed the relation of total sialic acid (TSA) and C Reactive Protein (CRP) as main components of acute phase proteins and cardiovascular risk profiles such as diabetes mellitus and smoking. We hypothesized that the elevation in the level of TSA along with other prototype acute phase reactants such as CRP is expected more in the coexistence of diabetes and smoking than in diabetes mellitus alone. Ninety diabetic patients were randomly selected and entered into this case-control study. Using block randomization method, the patients were randomly assigned into smokers (n=45) and nonsmokers (n=45). A group of ten healthy individuals was also included as the control. The serum levels of TSA, CRP, iron, and hemoglobin were measured by the specific techniques. Comparing laboratory parameters across the three groups indicated significantly higher levels of TSA and CRP in smoker diabetics as compared to non-smoker diabetics and the healthy controls, while there was no difference in other parameters including serum iron and hemoglobin. A significant positive correlation was also revealed between TCA and CRP (r=0.324, P=0.030), but no significant association was found between other parameters. In the background of smoking, increasing the level of both TSA and CRP is predicted more than the existence of diabetes mellitus alone. In fact, the increase in these biomarkers is more predictable in smoker than in nonsmoker diabetics. This finding emphasizes the increased risk for cardiovascular disorders in smoker compared to non-smoker diabetics.


Yeh HC, Duncan BB, Schmidt MI, Wang NY, Brancati FL. Smoking, smoking cessation, and risk for type 2 diabetes mellitus: a cohort study. Ann Intern Med 2010;152:10-7.

Nakanishi N, Nakamura K, Matsuo Y, Suzuki K, Tatara K. Cigarette smoking and risk for impaired fasting glucose and type 2 diabetes in middle-aged Japanese men. Ann Intern Med 2000;133:183-91.

Radzeviciene L, Ostrauskas R. Smoking habits and the risk of type 2 diabetes: a case control study. Diabetes Metab 2009;35:192-7.

InterAct Consortium, Spijkerman AM, van der A DL, Nilsson PM, Ardanaz E, Gavrila D,et al. Smoking and long-term risk of type 2 diabetes: the EPIC-InterAct study in European populations. Diabetes Care 2014;37:3164-71.

Ding EL& Hu FB. Smoking and Type 2 diabetes. Underrecognized risks and disease burden. JAMA 2007;298:2675-6.

Will JC, Galuska DA, Ford ES, Mokdad A, Calle EE. Cigarette smoking and diabetes mellitus: evidence of a positive association from a large prospective cohort study. Int J Epidemiol 2001;30:540-6.

Kowall B, Rathmann W, Strassburger K, Heier M, Holle R, Thorand B, et al. Association of passive and active smoking with incident type 2 diabetes mellitus in the elderly population: the KORA S4/F4 cohort study. Eur J Epidemiol 2010;25:393-402.

Ko KP, Min H, Ahn Y, Park SJ, Kim CS, Park JK,et al. A prospective study investigating the association between environmental tobacco smoke exposure and the incidence of type 2 diabetes in never smokers. Ann Epidemiol 2011;21:42-7.

Lajous M, Tondeur L, Fagherazzi G, de Lauzon-Guillain B, Boutron-Ruaualt MC, Clavel-Chapelon F. Childhood and adult secondhand smoke and type 2 diabetes in women. Diabetes Care 2013; 36(9):2720-5.

Wei X, Meng E, Yu S. A meta-analysis of passive smoking and risk of developing Type 2 Diabetes Mellitus. Diabetes Res Clin Pract 2015;107:9-14.

Fagard RH, Nilsson PM. Smoking and diabetes the double health hazard. Prim Care Diabetes 2009;3:205-9.

Lynch SM, Vrieling A, Lubin JH, Kraft P, Mendelsohn JB, Hartge P et al. Cigarette smoking and pancreatic cancer: a pooled analysis from the pancreatic cancer cohort consortium. Am J Epidemiol 2009;170:403-13.

Ye X, Lu G, Huai J, Ding J. Impact of smoking on the risk of pancreatitis: a systematic review and meta-analysis. PLoS One 2015;10:e0124075

Asmat U, Abad K, Ismail K. Diabetes mellitus and oxidative stress-A concise review. Saudi Pharm J 2016;24:547-553.

Matough FA, Budin SB, Hamid ZA, Alwahaibi N, Mohamed J. The role of oxidative stress and antioxidants in diabetic complications. Sultan Qaboos Univ Med J 2012;12:5-18.

Crook M1, Haq M, Haq S, Tutt P. Plasma sialic acid and acutephase proteins in patients with myocardial infarction. Angiology 1994;45:709-15.

Jain S1, Gautam V, Naseem S. Acute-phase proteins: As diagnostic tool. J Pharm Bioallied Sci 2011;3:118-27.

Lindberg G1, Råstam L, Gullberg B, Eklund GA, Törnberg S. Serum sialic acid concentration and smoking: a population based study. BMJ 1991;303:1306-7.

Abdella N1, Akanji AO, Mojiminiyi OA, Al Assoussi A, Moussa M. Relation of serum total sialic acid concentrations with diabetic complications and cardiovascular risk factors in Kuwaiti Type 2 diabetic patients. Diabetes Res Clin Pract 2000;50:65-72.

Crook MA, Pickup JC, Lumb PJ, Giorgino F, Webb DJ, Fuller JH, et al. Relationship between plasma sialic acid concentration and microvascular and macrovascular complications in type 1 diabetes: the EURODIAB Complications Study. Diabetes Care 2001;24:316-22.

Chen J1, Gall MA, Yokoyama H, Jensen JS, Deckert M, Parving HH. Raised serum sialic acid concentration in NIDDM patients with and without diabetic nephropathy. Diabetes Care 1996;19:130-4.

Pönniö M1, Alho H, Nikkari ST, Olsson U, Rydberg U, Sillanaukee P. Serum sialic acid in a random sample of the general population. Clin Chem 1999;45:1842-9.

Donath MY, Shoelson SE. Type 2 diabetes as an inflammatory disease. Nat Rev Immunol 2011.;11:98-107.

Lao XQ, Jiang CQ, Zhang WS, Adab P, Lam TH, Cheng KK, et al. Smoking, smoking cessation and inflammatory markers in older Chinese men: The Guangzhou Biobank Cohort Study. Atherosclerosi 2009;203:304-10.

Hastie CE, Haw S, Pell JP. Impact of smoking cessation and lifetime exposure on C-reactive protein. Nicotine Tob Res 2008;10:637-42.

Wang X, Bao W, Liu J, Ouyang YY, Wang D, Rong S, et al. Inflammatory markers and risk of type 2 diabetes: a systematic review and meta-analysis. Diabetes Care 2013;36:166-75.

Ong KL, Tso AW, Xu A, Law LS, Li M, Wat NM, et al. Evaluation of the combined use of adiponectin and C-reactive protein levels as biomarkers for predicting the deterioration in glycaemia after a median of 5.4 years. Diabetologia 2011;54:2552-60.

Rom O, Avezov K, Aizenbud D, Reznick AZ. Cigarette smoking and inflammation revisited. Respir Physiol Neurobiol 2013;187:5-10.

Fröhlich M, Sund M, Löwel H, Imhof A, Hoffmeister A, Koenig W. Independent association of various smoking characteristics with markers of systemic inflammation in men. Results from a representative sample of the general population (MONICA Augsburg Survey 1994/95). Eur Heart J 2003;24:1365-72.

Madsen C, Nafstad P, Eikvar L, Schwarze PE, Rønningen KS, Haaheim LL. Association between tobacco smoke exposure and levels of C-reactive protein in the Oslo II Study. Eur J Epidemiol 2007;22:311-7.

Levitzky YS, Guo CY, Rong J, Larson MG, Walter RE, Keaney JF Jr, et al. Relation of smoking status to a panel of inflammatory markers: the framingham offspring. Atherosclerosis 2008;201:217-24

How to Cite
Rezaei-Adl S, Ghahroudi Tali A, Saffar H, Rajabiani A, Abdollahi A. Comparing the Levels of Acute-Phase Reactants Between Smoker and Nonsmoker Diabetic Patients: More Predicted Risk for Cardiovascular Diseases in Smoker Compared to Nonsmoker Diabetics. Acta Med Iran. 55(9):563-567.