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Relationship between glycated hemoglobin and low Ankle-Brachial Index: a cross-sectional observational study from the
Huan Liu1, Jinbo Liu1, Hongwei Zhao1
1Department of Vascular Medicine, Peking University Shougang Hospital, Beijing, China.
Insights
High glycated hemoglobin (HbA1c) is an independent risk factor for low Ankle Brachial Index (ABI), a marker of cardiovascular disease. This linear correlation persists even after accounting for other cardiovascular risk factors.
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Vascular Biology
Background:
- Low Ankle Brachial Index (ABI) and high glycated hemoglobin (HbA1c) are established cardiovascular disease (CVD) risk factors.
- The independent association between HbA1c and ABI has been underexplored.
Purpose of the Study:
- To evaluate the independent relationship between HbA1c and low ABI.
- To determine if HbA1c is a predictor of reduced ABI.
Main Methods:
- 3102 subjects (aged 67.72±10.69 years) were analyzed from 2010-2018.
- Multivariable logistic and linear regression models assessed the association between HbA1c and ABI, adjusting for confounders.
Main Results:
- Individuals with low ABI exhibited significantly higher rates of older age, smoking, hypertension, diabetes, and CVD.
- After multiple adjustments, HbA1c remained a statistically significant predictor of low ABI (OR: 1.204-1.410, P<0.001).
- HbA1c showed an independent linear correlation with both left and right ABI (P<0.001).
Conclusions:
- HbA1c is an independent factor associated with lower ABI, linearly correlating with ABI levels irrespective of fasting plasma glucose and other cardiovascular factors.
- Clinical focus should extend beyond diabetic patients to include individuals with low ABI when assessing cardiovascular risk related to HbA1c.
Background:
Studies have confirmed that the low Ankle Brachial Index (ABI) and high glycated hemoglobin (HbA1c) level were both risk factors of cardiovascular disease (CVD). However, the association has rarely been explored between ABI and HbA1c. This study was to evaluate the independent relationship between HbA1c and low ABI.
Methods:
A total of 3102 subjects (male 1539, female 1563, aged 67.72±10.69 years) were enrolled into the study from 2010 to 2018. The odds ratio (OR) and linear regression coefficient of low ABI group (defined as ABI≤0.9) and ABI value in associations with the HbA1c were modelled using multivariable logistic and linear regression analyses by adjusting for possible confounders.
Results:
Compared with participants with normal ABI, those presenting the low ABI showed a significantly older age, smoking rate, higher level of heart rate (HR), systolic blood pressure (SBP), pulse pressure (PP), fasting plasma glucose (FPG), triglyceride (TG), highly sensitive C-reactive protein (hs-CRP), HbA1c and carotid femoral pulse wave velocity (CF-PWV); and higher prevalence rate of hypertension, diabetes, coronary artery disease (CAD); and higher rate on medication of statins, diabetes drug and cardiovascular drug (all P<0.001). After multiple adjustment for age, sex, smoke, FPG, blood lipids, hs-CRP, SBP, diastolic blood pressure (DBP), PP, CF-PWV, hypertension, diabetes, CAD and medications, the OR of HbA1c for low ABI was of statistical significance (95% CI: 1.204-1.410, P<0.001). After further multivariate adjustment analysis by linear regression, with left and right ABI as dependent variables, the results showed that HbA1c was independently linearly correlated to left and right ABI (all P<0.001).
Conclusions:
HbA1c was an independent associated factor of lower ABI and linearly correlated to ABI level independent of fasting plasma glucose and other cardiovascular factors. We should not only focus on the HbA1c in diabetes mellitus patients, but also people with lower ABI.
