The Association between Hemoglobin A1c and Subclinical Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis.

  1. Marguerite J. McNeely, MD, MPH (mcneely{at}u.washington.edu)1,
  2. Robyn L. McClelland, PhD2,
  3. Diane E. Bild, MD, MPH3,
  4. David R. Jacobs, Jr, PhD4,5,
  5. Russell P. Tracy, PhD6,7,
  6. Mary Cushman, MD, MSc6,8,
  7. David C. Goff, Jr, MD, PhD9,10,
  8. Brad C. Astor, PhD1112,
  9. Steven Shea, MD, MS1314 and
  10. David S. Siscovick, MD, MPH1,15
  1. 1Department of Medicine, University of Washington, Seattle, WA
  2. 2Department of Biostatistics, University of Washington, Seattle, WA
  3. 3Division of Prevention and Population Sciences, National Heart, Lung and Blood Institute, Bethesda, MD
  4. 4Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
  5. 5Department of Nutrition, University of Oslo, Oslo, Norway
  6. 6Department of Pathology, University of Vermont, Burlington, VT
  7. 7Department of Biochemistry, University of Vermont, Burlington, VT
  8. 8Department of Medicine, University of Vermont, Burlington, VT
  9. 9Division of Public Health Sciences, Wake Forest University, Winston-Salem, NC
  10. 10Department of Internal Medicine, Wake Forest University, Winston-Salem, NC
  11. 11Department of Epidemiology, Johns Hopkins University, Baltimore, MD
  12. 12Department of Medicine, Johns Hopkins University, Baltimore, MD
  13. 13Department of Medicine, Columbia University, New York, NY
  14. 14Department of Epidemiology, Columbia University, New York, NY
  15. 15Department of Epidemiology, University of Washington, Seattle, WA

    Abstract

    Objective: To test the hypothesis that hemoglobin A1c (A1c) is associated with subclinical cardiovascular disease (CVD) in a population without evident diabetes, after adjusting for traditional CVD risk factors and BMI.

    Research design and methods: A cross-sectional study of 5121 participants without clinically evident CVD or diabetes (fasting glucose ≥7.0 mmol/l or use of diabetes medication), aged 47-86 years, enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA). Measurements included carotid intimal-medial wall thickness (CIMT) and coronary artery calcification (CAC). Results were adjusted for age, sex, ethnicity, smoking, systolic blood pressure, LDL-cholesterol, HDL-cholesterol, antihypertensive medication use, lipid-lowering medication use, and BMI.

    Results: Compared with those in the lowest quartile for A1c (5.0 ± 0.2%, mean ± SD), participants in the highest quartile (6.0 ± 0.3%) had higher adjusted mean values for common CIMT (0.85 versus 0.87 mm, p=0.003) and internal CIMT (1.01 versus 1.08 mm, p=0.003). A1c quartile was not associated with prevalence of CAC in the entire cohort (p=0.27), however the association was statistically significant in women (adjusted prevalence of CAC in lowest and highest A1c quartiles 37.5% versus 43.0%, p=0.01). Among those with some CAC, higher A1c quartile tended to be associated with higher CAC score, but the results were not statistically significant (adjusted p=0.11).

    Conclusions: In this multi-ethnic cohort, there were small, positive associations between A1c, common CIMT and internal CIMT in the absence of clinically evident diabetes. An association between higher A1c and CAC prevalence was evident only in women.

    Footnotes

      • Received January 14, 2009.
      • Accepted June 13, 2009.

    This Article

    1. Published online before print June 23, 2009, doi: 10.2337/dc09-0074
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