Abstract
BackgroundIt is not clear which glucose measure is more useful in the assessment of atherosclerosis. We investigated the associations of hemoglobin A1c (HbA1c), glycated albumin (GA), 1,5-anhydroglucitol (1,5-AG), fasting plasma glucose (FPG), and 2-hour postload glucose (PG) with carotid intima-media thickness (IMT) in community-dwelling Japanese subjects.MethodsA total of 2702 subjects aged 40–79 years underwent a 75-g oral glucose tolerance test and measurements of HbA1c, GA, 1,5-AG, and carotid IMT by ultrasonography in 2007–2008. Carotid wall thickening was defined as a maximum IMT of >1.0 mm. The crude and multivariable-adjusted linear and logistic regression models were used to analyze cross-sectional associations between levels of glycemic measures and carotid IMT.ResultsThe crude average of the maximum IMT increased significantly with rising quartiles of HbA1c, GA, FPG, and 2-hour PG levels in subjects with and without glucose intolerance (GI), while no clear association was observed for 1,5-AG. After adjustment for other confounding factors, positive trends for HbA1c, GA, and FPG (all p for trend < 0.05), but not 2-hour PG (p = 0.07) remained robust in subjects with GI, but no such associations were found in those without GI. When estimating multivariable-adjusted β values for the associations of 1 SD change in glycemic measures with the maximum IMT in subjects with GI, the magnitude of the influence of HbA1c (β = 0.021), GA (β = 0.024), and FPG (β = 0.024) was larger than that of 2-hour PG (β = 0.014) and 1,5-AG (β = 0.003). The multivariable-adjusted odds ratios for the presence of carotid wall thickening increased significantly with elevating HbA1c, GA, and FPG levels only in subjects with GI (all p for trend < 0.001). Among subjects with GI, the area under the receiver operating characteristic curve significantly increased by adding HbA1c (p = 0.04) or GA (p = 0.04), but not 1,5-AG, FPG, or 2-hour PG, to the model including other cardiovascular risk factors.ConclusionsIn community-dwelling Japanese subjects with GI, elevated HbA1c, GA, and FPG levels were significantly associated with increased carotid IMT, and HbA1c and GA provided superior discrimination for carotid wall thickening compared to 1,5-AG, FPG, and 2-hour PG, suggesting that HbA1c and GA are useful for assessing carotid atherosclerosis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12933-015-0247-7) contains supplementary material, which is available to authorized users.
Highlights
It is not clear which glucose measure is more useful in the assessment of atherosclerosis
To investigate which glucose measure is more useful in the assessment of atherosclerosis, we examined the associations of hemoglobin A1c (HbA1c), glycated albumin (GA), 1,5-AG, fasting plasma glucose (FPG), and 2-hour postload glucose (PG) levels with carotid intima-media thickness (IMT) in a community-dwelling Japanese population stratified by glucose tolerance status, and compared the magnitude of the influence of these five glycemic measures on the ability to discriminate carotid wall thickening
The mean values of age, maximum IMT, HbA1c, GA, FPG, 2-hour PG, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), systolic and diastolic blood pressures, body mass index (BMI), low-density lipoprotein (LDL) cholesterol, and triglycerides, and the frequencies of men, insulin resistance, hypertension, antihypertensive and lipid-lowering medications, hyper-LDL cholesterolemia, proteinuria, Chronic kidney disease (CKD), and history of cardiovascular disease (CVD) were significantly higher in subjects with glucose intolerance (GI) than in those with normal glucose tolerance (NGT), and subjects with GI had significantly lower 1,5-AG, high-density lipoprotein (HDL) cholesterol, and estimated glomerular filtration rate (eGFR) values
Summary
It is not clear which glucose measure is more useful in the assessment of atherosclerosis. Several population-based epidemiological studies in Asian populations [2,3,4,5] as well as in Western populations [6,7,8,9,10,11,12,13] have focused on the association between HbA1c levels and intima-media thickness (IMT) of carotid arteries, which is generally accepted as a marker of the early stage of atherosclerosis This issue has not been assessed sufficiently in a general Japanese population [5]. To our knowledge, there are no data comparing HbA1c, GA, 1,5-AG, fasting plasma glucose (FPG), and 2-hour postload glucose (PG) measurements as a tool for the assessment of atherosclerosis
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