Abstract
OBJECTIVE: To analyze the available evidence regarding the association between C-peptide and cardiovascular and overall mortality. METHODS: A systematic review of MEDLINE and EMBASE was performed. Articles published in English, Portuguese, or Spanish, reporting observational studies investigating the association between C-peptide and cardiovascular or overall mortality were included. The association between C-peptide and cardiometabolic risk factors, hemodynamic factors, and anthropometric measures was also investigated. The methodological quality of studies was assessed using the Newcastle-Ottawa Scale. RESULTS: The literature search revealed 107 articles on the topic of interest. Following the screening step, 18 articles presenting data on the association between C-peptide and cardiovascular risk were included. Five studies provided data on the relationship between C-peptide and cardiovascular or overall mortality. C-peptide was positively associated with body mass index in Chinese individuals, and inversely associated with HDL cholesterol in population samples from Asia, Middle East, and the United Stated. Nevertheless, meta-analysis of cardiovascular risk components was not possible. In the meantime, C-peptide was associated with cardiovascular mortality (RR = 1.62; 95%CI: 0.99-2.66) and overall mortality (RR = 1.39; 95%CI: 1.04-1.84). CONCLUSIONS: The present systematic review and meta-analysis showed that serum levels of C-peptide were positively associated with overall mortality in all individuals and with cardiovascular mortality in individuals without comorbidities. Based on these results, it is possible to recommend the use of C-peptide in clinical practice as a proxy of insulin resistance associated with cardiovascular mortality.