Glycemic Markers and Subclinical Cardiovascular Disease: The Jackson Heart Study. (March 2019)

• Record Type: Journal Article
• Authors: Echouffo-Tcheugui, Justin B.; Chen, Haiying; Kalyani, Rita R.; Sims, Mario; Simpson, Sean; Effoe, Valery S.; Correa, Adolfo; Bertoni, Alain G.; Golden, Sherita H.
• Is Part Of: Circulation. Volume 12:Number 3(2019)
• Publication Date: 2019-03
• Subjects: blood glucose -- cardiovascular diseases -- female -- glycated hemoglobin A -- humans -- insulin resistance; Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.1075405
• DOI: 10.1161/CIRCIMAGING.118.008641
• Languages: English
• ISSNs: 1941-9651

Abstract

Abstract : Background: We investigated the associations of glycemic markers (HbA1C [hemoglobin A1C ], fasting plasma glucose, and insulin resistance—homeostasis model assessment of insulin resistance) with subclinical cardiovascular disease (CVD) among blacks. Methods: We included 4303 community-dwelling blacks (64% women; mean age, 54.5 years) without prevalent CVD. Subclinical CVD was defined as ≥1 of the following: any coronary artery calcification (CAC), elevated carotid intima-media thickness (cIMT), left ventricular (LV) hypertrophy, LV ejection fraction <50%, and peripheral artery disease (ankle-brachial index, <0.90). Estimates of cross-sectional associations of glycemic markers (fasting plasma glucose, HbA1C, and homeostasis model assessment of insulin resistance) with subclinical CVD measures were adjusted for traditional CVD risk factors. Results: Each 1% increment in HbA1C was associated with higher odds of CAC, abnormal cIMT, and subclinical CVD (all P <0.001). Adjusted mean values of LV mass (LVM), LVM index, relative wall thickness, CAC, and cIMT were increasingly abnormal with worsening HbA1C categories (all P <0.05). Each 10-mg/dL increase in fasting plasma glucose was associated with higher odds of LV hypertrophy, CAC, abnormal cIMT, and subclinical CVD (all P <0.005). Adjusted mean values of LVM, LVM index, relative wall thickness, CAC, ankle-brachial index, and cIMT were more abnormal across categories of worsening fasting plasma glucose (all P <0.05). Each unit increment in log-transformed homeostasis model assessment of insulin resistance conferred a higher odd of having LV hypertrophy ( P <0.01). Across quartiles of homeostasis model assessment of insulin resistance, we observed progressively abnormal adjusted mean values of LVM, LVM index, relative wall thickness, and ankle-brachial index (all P <0.01). Conclusions: Among blacks, glycemic markers were differentially associated with various measures of subclinical CVD. Abstract : Supplemental Digital Content is available in the text.