Abstract
ObjectiveArterial and ventricular stiffening are characteristics of diabetes and aging which confer significant morbidity and mortality; advanced glycation endproducts (AGE) are implicated in this stiffening pathophysiology. We examined the association between HbA1c, an AGE, with arterial and ventricular stiffness measures in older individuals without diabetes.Research Design & MethodsBaseline HbA1c was measured in 830 participants free of diabetes defined by fasting glucose or medication use in the Cardiovascular Health Study, a population-based cohort study of adults aged ≥65 years. We performed cross-sectional analyses using baseline exam data including echocardiography, ankle and brachial blood pressure measurement, and carotid ultrasonography. We examined the adjusted associations between HbA1c and multiple arterial and ventricular stiffness measures by linear regression models and compared these results to the association of fasting glucose (FG) with like measures.ResultsHbA1c was correlated with fasting and 2-hour postload glucose levels (r = 0.21; p<0.001 for both) and positively associated with greater body-mass index and black race. In adjusted models, HbA1c was not associated with any measure of arterial or ventricular stiffness, including pulse pressure (PP), carotid intima-media thickness, ankle-brachial index, end-arterial elastance, or left ventricular mass (LVM). FG levels were positively associated with systolic, diastolic and PP and LVM.ConclusionsIn this sample of older adults without diabetes, HbA1c was not associated with arterial or ventricular stiffness measures, whereas FG levels were. The role of AGE in arterial and ventricular stiffness in older adults may be better assessed using alternate AGE markers.
Highlights
Increased arterial and ventricular stiffness are hallmarks of aging and its attendant comorbidity [1]
HbA1c was not associated with any measure of arterial or ventricular stiffness, including pulse pressure (PP), carotid intima-media thickness, ankle-brachial index, endarterial elastance, or left ventricular mass (LVM)
fasting glucose (FG) levels were positively associated with systolic, diastolic and PP and LVM
Summary
Increased arterial and ventricular stiffness are hallmarks of aging and its attendant comorbidity [1]. Ventricular stiffness is associated with left ventricular hypertrophy (LVH) and delayed early diastolic filling which, in turn, increase the risk of heart failure (HF), and death [2]. People with diabetes, both young and old, carry an even higher risk of arterial and ventricular stiffness and its cardiovascular sequelae [3,4]. Age-associated arterial changes include increased intima-medial thickness (IMT), smooth muscle hypertrophy, collagen accrual and cross-linking, fibrosis, and inflammation [1]. AGE may play an important role in arterial and ventricular stiffness associated with aging even in individuals without diabetes, but with evidence of elevated blood glucose levels
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