Glycemic Control, Atherosclerosis, and Risk Factors for Cardiovascular Disease in Individuals With Diabetes

The Atherosclerosis Risk in Communities study

  1. Elizabeth Selvin, PHD, MPH12,
  2. Josef Coresh, MD, PHD123,
  3. Sherita H. Golden, MD, MHS123,
  4. Lori L. Boland, MPH4,
  5. Frederick L. Brancati, MD, MHS123 and
  6. Michael W. Steffes, MD, PHD5
  1. 1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  2. 2Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
  3. 3Johns Hopkins School of Medicine, Baltimore, Maryland
  4. 4Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
  5. 5Department of Laboratory Medicine and Pathology, Medical School, University of Minnesota, Minneapolis, Minnesota
  1. Address correspondence and reprint requests to Elizabeth Selvin, Ph.D., MPH, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument St., Suite 2-600, Baltimore, MD 21205. E-mail: lselvin{at}jhsph.edu

Abstract

OBJECTIVE—Glycemic control (HbA1c [A1C]) is strongly associated with microvascular disease in individuals with diabetes, but its relation to macrovascular disease and atherosclerosis is less clear. This study examines the relationship between A1C, carotid intima-media thickness (IMT), and traditional cardiovascular risk factors in individuals with diabetes.

RESEARCH DESIGN AND METHODS—A cross-sectional study of 2,060 people with diagnosed and undiagnosed (unrecognized) diabetes in the Atherosclerosis Risk in Communities study was performed.

RESULTS—LDL and HDL cholesterol, plasma triglycerides, and waist-to-hip ratio were significantly associated with A1C after multivariable adjustment. African Americans with undiagnosed and diagnosed diabetes had significantly elevated A1C values compared with whites, even after adjustment for potentially confounding factors. There was a graded association between A1C and carotid IMT. In a fully adjusted model in individuals with undiagnosed diabetes, the odds ratio (OR) of being in the highest quartile of IMT versus the lowest was 2.46 (95% CI 1.16–5.03, comparing the highest quartile of A1C to the lowest). In people with diagnosed diabetes, the comparable OR was 2.62 (1.36–5.06).

CONCLUSIONS—This study identified several important associations between A1C and known risk factors for cardiovascular disease and suggested that A1C is independently related to carotid IMT. Chronically elevated glucose levels may contribute to the development of atherosclerosis in people with diabetes, independent of other risk factors.

Footnotes

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Accepted April 24, 2005.
    • Received January 14, 2005.
« Previous | Next Article »Table of Contents

This Article

  1. doi: 10.2337/diacare.28.8.1965 Diabetes Care August 2005 vol. 28 no. 8 1965-1973
  1. » Abstract
  2. Full Text
  3. Full Text (PDF)

Current Issue

  1. November 2009, 32 (11)
  1. Current Issue
  1. Alert me to new issues of Diabetes Care