The Relationship Between Dysglycemia and Atherosclerosis in South Asian, Chinese, and European Individuals in Canada
A randomly sampled cross-sectional study
- Hertzel C. Gerstein, MD, MSC1,
- Sonia Anand, MD, MSC1,
- Qi Long Yi, MSC12,
- Vladimir Vuksan, PHD3,
- Eva Lonn, MD, MSC1,
- Koon Teo, MBBCH1,
- Klas Malmberg, MD, PHD4,
- Matthew McQueen, MBCHB1,
- Salim Yusuf, MD, MBBS, DPHILa and
- For the SHARE Investigators*
- 1McMaster University and the Population Health Research Institute, Hamilton, Ontario, Canada
- 2Princess Margaret Hospital and the University of Toronto, Toronto, Ontario, Canada
- 3Risk Factor Modification Center, St. Michael’s Hospital and the University of Toronto, Toronto, Ontario, Canada
- 4Department of Cardiology, Karolinska Institute, Stockholm, Sweden
Abstract
OBJECTIVE—Raised glucose levels extending from normal into the diabetic range (dysglycemia) are an emerging risk factor for clinical cardiovascular events. The relationship between dysglycemia and atherosclerosis (AS) in the general population and in different ethnic groups remains controversial.
RESEARCH DESIGN AND METHODS—Glucose tolerance, HbA1c, other metabolic risk factors for AS, and carotid mean maximal intimal media thickness were assessed in a random sample of 979 Canadians of South Asian, Chinese, and European descent.
RESULTS—The age and sex-adjusted intimal medial thickness increased 0.026 mm for every 0.9% increase in HbA1c in all participants (P < 0.0001) and in those of South Asian (P = 0.018), Chinese (P = 0.002), and European (P < 0.0001) descent. This progressive curvilinear relationship was most apparent at HbA1c levels >5.7%. The HbA1c-AS relationship persisted after adjustment for ethnicity, age, sex, diabetes status, abdominal obesity, insulin resistance, insulin secretion, fasting free fatty acids, blood pressure, and/or dyslipidemia (P < 0.004). Both diabetes (P = 0.002) and HbA1c (P < 0.0001) were determinants of the intimal medial thickness when included in separate statistical models. When included together in a single model, HbA1c (P < 0.0001) but not diabetes (P = 0.6) was a significant determinant.
CONCLUSIONS—The degree of AS is related to the level of HbA1c irrespective of diabetes status and independent of abdominal obesity and other markers of the metabolic syndrome. This progressive relationship between HbA1c and AS was observed within different ethnic groups.
- AS, atherosclerosis
- CV, cardiovascular
- HOMA, homeostasis model assessment
- HOMA-β, HOMA for β-cell secretion
- HOMA-IR, HOMA for insulin resistance
- IMT, intimal media thickness
- MMIMT, maximum IMT
- SHARE, Study of Health Assessment and Risk in Ethnic Groups
Footnotes
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Address correspondence and reprint requests to Dr. H.C. Gerstein, Department of Medicine, Room 3V38, 1200 Main St. West, Hamilton, Ontario, L8N 3Z5, Canada. E-mail: gerstein{at}mcmaster.ca.
Received for publication 12 June 2002 and accepted in revised form 7 October 2002.
*A list of the SHARE investigators can be found in reference 11.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
- DIABETES CARE
