Glycemia, Insulin Sensitivity Markers and Arterial Stiffness: The Framingham Heart Study

There is limited data on the associations of (glycated hemoglobin A1C [HbA_1C], fasting plasma glucose, and 2-hour postload glucose) and insulin resistance (fasting plasma insulin, insulin-to-glucose ratio, homeostasis model assessment of insulin resistance, and quantitative insulin sensitivity check index) markers with arterial stiffness.

We included 6617 Framingham Heart Study participants (53.8% women; 6.9% diabetes, mean age: 48±14 years). Arterial stiffness measures included natural log (Ln)-transformed carotid-femoral pulse wave velocity, augmentation index (AIx), central pulse pressure, carotid-brachial pulse wave velocity, carotid-radial pulse wave velocity, and brachial pulse pressure. Estimates of associations were adjusted for several clinical characteristics.

Adjusted means of log (Ln)-transformed carotid-femoral pulse wave velocity, AIx, and carotid-brachial pulse wave velocity were increasingly abnormal with higher HbA_1C (all P<0.05). Each 1% higher HbA_1C was associated with elevated CFPWV (odds ratio [OR], 1.24 [95% CI, 1.11-1.39]) and lower AIx (OR, 0.86 [95% CI, 0.78-0.95]). Each 10-mg/dL higher fasting plasma glucose was associated with elevated CFPWV (OR, 1.09 [95% CI, 1.05-1.13]), but lower AIx (OR, 0.91 [95% CI, 0.87-0.94]). Each 10-mg/dL higher 2-hour postload glucose was associated with elevated CFPWV (OR, 1.04 [95% CI, 1.01-1.07]), central pulse pressure (OR, 1.04 [95% CI, 1.02-1.06]), brachial pulse pressure (OR, 1.04 [95% CI, 1.02-1.06]), but lower AIx (OR, 0.94 [95% CI, 0.91-0.96]). Higher fasting plasma insulin, insulin-to-glucose ratio, homeostasis model assessment of insulin resistance, and lower quantitative insulin sensitivity check index were associated with higher CFPWV and lower AIx (all P<0.05).

In community-dwelling individuals, worse glycemia and insulin sensitivity were associated with abnormal arterial stiffness.