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Glycemic Markers and Subclinical Cardiovascular Disease: The Jackson Heart Study
Justin B Echouffo-Tcheugui1, Haiying Chen2, Rita R Kalyani1
1Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MA (J.B.E.-T., R.R.K., S.H.G.).
Insights
High blood sugar markers like hemoglobin A1C and fasting plasma glucose are linked to subclinical cardiovascular disease in Black adults. Insulin resistance also shows associations with left ventricular hypertrophy and other CVD indicators.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Subclinical cardiovascular disease (CVD) is a precursor to overt CVD.
- Glycemic markers, including hemoglobin A1C (HbA1C), fasting plasma glucose (FPG), and insulin resistance (homeostasis model assessment of insulin resistance, HOMA-IR), are crucial in metabolic health.
- Understanding their association with subclinical CVD in specific populations like Black adults is vital for targeted prevention strategies.
Purpose of the Study:
- To investigate the associations between glycemic markers (HbA1C, FPG, HOMA-IR) and various measures of subclinical cardiovascular disease (CVD) among Black adults.
- To identify which glycemic markers are most strongly associated with different indicators of subclinical CVD.
Main Methods:
- Cross-sectional study including 4303 community-dwelling Black adults without prevalent CVD.
- Subclinical CVD was assessed using coronary artery calcification (CAC), carotid intima-media thickness (cIMT), left ventricular (LV) hypertrophy, reduced LV ejection fraction, and peripheral artery disease (ankle-brachial index <0.90).
- Glycemic markers (HbA1C, FPG, HOMA-IR) were analyzed for their association with subclinical CVD measures, adjusted for traditional CVD risk factors.
Main Results:
- Higher HbA1C levels were significantly associated with increased odds of CAC, abnormal cIMT, and overall subclinical CVD.
- Elevated FPG levels correlated with higher odds of LV hypertrophy, CAC, abnormal cIMT, and subclinical CVD.
- Increased HOMA-IR was linked to a higher likelihood of LV hypertrophy and progressively abnormal measures of LV mass and ankle-brachial index across its quartiles.
Conclusions:
- Glycemic markers, including HbA1C, FPG, and HOMA-IR, show significant differential associations with various subclinical CVD measures in Black adults.
- These findings highlight the importance of glycemic control in preventing cardiovascular complications within this demographic.
- Targeting glycemic dysregulation may be a key strategy in mitigating subclinical CVD risk among Black individuals.
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.
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