C-peptide Independently Associated With Subclinical Myocardial Injury

cardiac MRI, cardiovascular
C-peptide level may be independently associated with both cardiac injury score (CIIS) and subclinical myocardial injury.

C-peptide level may be independently associated with both cardiac injury score (CIIS) and subclinical myocardial injury (SC-MI), according to recently published research.  

In order to evaluate the relationship between serum C-peptide and SC-MI, researchers utilized data from the US National Health and Nutrition Examination Survey III (NHANES III). After exclusion of those with missing circulating C-peptide data, a total of 3752 participants without a cardiovascular disease history were included.

Study covariates included baseline demographics, risk factor for cardiovascular diseases, and factors influencing C-peptide levels. Age, gender, race, and other sociodemographic variables were collected through standardized questionnaires. Physical examinations were undertaken to collect data on systolic and diastolic blood pressure, pulse rate, height, and weight.

Average participant age was 60.3±33.1; 47.3% were men. Participants with high levels of C-peptide were older men, and had higher body mass index, total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), C-reactive protein (CRP), glucose, and glycated hemoglobin.

As C-peptide quartile increased, CIIS was higher. Results of a multivariable linear regression analysis, adjusting for age and sex, found that circulating C-peptide was positively related to CIIS (b=.13; 95% CI, 0.06-0.19). This linear relationship existed after additional adjustments for lifestyle were made, and following laboratory examinations (b=.09 and 0.09; 95% CI, 0.00-0.17 and 0.00-0.17, respectively).

Across quartiles, prevalence of SC-MI was 31.6%, 31.3%, 38.6%, and 43.6%. When compared with the lowest quartile, the highest quartile was associated significantly with SC-MI after adjustment for sociodemographic factors (odds ratio [OR], 1.59; 95% CI, 1.31-1.92). This association remained statistically significant after further adjustments.

Additionally, researchers found that a 1-unit increase in C-peptide was associated with a 1.27-fold higher risk of SC-MI (OR, 1.27; 95% CI, 1.08-1.50).

Results of a subgroup analysis showed that the association between C-peptide and SC-MI was consistent across both age and gender. Additionally, investigators found that a higher level of C-peptide increased SC-MI risk across disease severity, although this was only significant in the borderline abnormality group.

Study limitations include the cross-sectional nature and the inclusion only of baseline C-peptide.

“Our study confirmed that circulating C-peptide level was independently associated with electrocardiographic subclinical myocardial injury after adjusting for cardiovascular risk factors and glucose metabolism-related biomarkers,” the researchers concluded.


Chen Z, He J, Ma Q, Xiao M. Association between C-peptide level and subclinical myocardial injury. Front Endocrinol. Published online August 12, 2021. doi:10.3389/fendo.2021.680501