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Diabetologia
Published in: Diabetologia 1/2009

01-01-2009 | Article

Association of impaired fasting glucose and coronary artery calcification as a marker of subclinical atherosclerosis in a population-based cohort—results of the Heinz Nixdorf Recall Study

Authors: S. Moebus, A. Stang, S. Möhlenkamp, N. Dragano, A. Schmermund, U. Slomiany, B. Hoffmann, M. Bauer, M. Broecker-Preuss, K. Mann, J. Siegrist, R. Erbel, K.-H. Jöckel, Heinz Nixdorf Recall Study Group

Published in: Diabetologia | Issue 1/2009

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Abstract

Aims/hypothesis

Atherosclerosis and cardiovascular diseases are often present at the time of diagnosis of type 2 diabetes mellitus. Whether subclinical atherosclerosis can be detected in the pre-diabetic (borderline fasting hyperglycemia) state is not clear. This study investigated the association of impaired fasting glucose (IFG) and coronary artery calcification (CAC), a marker of subclinical atherosclerosis, among participants without a history of coronary heart disease or manifest diabetes mellitus.

Methods

Study participants (aged 45–75 years) of the population-based Heinz Nixdorf Recall Study were categorised into those with normal fasting glucose (glucose <6.1 mmol/l) and those with IFG (glucose ≥6.1 to <7.0 mmol/l), excluding participants with a history of CHD or diabetes mellitus. CAC was assessed by electron-beam computed tomography, and risk factors were assessed by extended interviews, anthropometric measurements and laboratory tests. Various CAC cut-off points were used in multiple logistic and ordinal logistic regression models to estimate ORs and 95% CIs.

Results

Of the 2,184 participants, more men had IFG than did women (37% vs 22%). Participants with IFG showed a higher prevalence of CAC  > 0 (men OR 1.90, 95% CI 1.33–2.70; women 1.63, 1.23–2.15). Risk factor adjustment weakened this association in both sexes (men 1.63, 1.12–1.36; women 1.26, 0.93–1.70). When the age- and sex-specific 75th percentile was used as the cut-off point for CAC, the association further decreased in men (1.10, 0.81–1.50), but became stronger in women (1.41, 1.02–1.94).

Conclusions/interpretation

These data support the hypothesis that CAC is already present in the pre-diabetic state and that IFG has a modest and independent impact on the atherosclerotic process. Biological sex appears to modify the association between IFG and CAC.
Appendix
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Literature
1.
Laakso M, Lehto S (1997) Epidemiology of macrovascular disease in diabetes. Diabetes Rev 5:294–315
2.
Wild S, Roglic G, Green A, Sicree R, King H (2004) Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 27:1047–1053PubMedCrossRef
3.
Haffner SM, Stern MP, Hazuda HP, Mitchell BD, Patterson JK (1990) Cardiovascular risk factors in confirmed prediabetic individuals. Does the clock for coronary heart disease start ticking before the onset of clinical diabetes. JAMA 263:2893–2898PubMedCrossRef
4.
5.
The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (1997) Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 20:1183–1197
6.
7.
8.
Reaven GM (2005) Insulin resistance, the insulin resistance syndrome, and cardiovascular disease. Panminerva Med 47:201–210PubMed
9.
Greenland P, Bonow RO, Brundage BH et al (2007) ACCF/AHA 2007 Clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: A Report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force Developed in Collaboration With the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol 49:378–402PubMedCrossRef
10.
Olson JC, Edmundowicz D, Becker DJ, Kuller LH, Orchard TJ (2000) Coronary calcium in adults with type 1 diabetes: a stronger correlate of clinical coronary artery disease in men than in women. Diabetes 49:1571–1578PubMedCrossRef
11.
Mielke CH, Shields JP, Broemeling LD (2001) Coronary artery calcium, coronary artery disease, and diabetes. Diabetes Res Clin Pract 53:55–61PubMedCrossRef
12.
Schurgin S, Rich S, Mazzone T (2001) Increased prevalence of significant coronary artery calcification in patients with diabetes. Diabetes Care 24:335–338PubMedCrossRef
13.
Wolfe ML, Iqbal N, Gefter W et al (2002) Coronary artery calcification at electron beam computed tomography is increased in asymptomatic type 2 diabetics independent of traditional risk factors. J Cardiovasc Risk 9:369–376PubMedCrossRef
14.
Elkeles RS, Feher MD, Flather MD et al (2004) The association of coronary calcium score and conventional cardiovascular risk factors in type 2 diabetic subjects asymptomatic for coronary heart disease (The PREDICT Study). Diab Med 21:1129–1134CrossRef
15.
Schmermund A, Möhlenkamp S, Stang A et al (2002) Assessment of clinically silent atherosclerotic disease and established and novel risk factors for predicting myocardial infarction and cardiac death in healthy middle-aged subjects: rationale and design of the Heinz Nixdorf Recall Study. Risk factors, evaluation of coronary calcium and lifestyle. Am Heart J 144:212–218PubMedCrossRef
16.
Stang A, Moebus S, Dragano N et al (2005) Baseline recruitment and analyses of nonresponse of the Heinz Nixdorf Recall Study: identifiability of phone numbers as the major determinant of response. Eur J Epidemiol 20:489–496PubMedCrossRef
17.
18.
Agatston AS, Janowitz WR, Hildner FJ et al (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832PubMedCrossRef
19.
Stang A, Moebus S, Möhlenkamp S et al (2006) Algorithms for converting random-zero to automated oscillometric blood pressure values, and vice versa. Am J Epidemiol 164:85–94PubMedCrossRef
20.
Rumberger JA, Brundage BH, Rader DJ, Kondos G (1999) Electron beam computed tomographic coronary calcium scanning: a review and guidelines for use in asymptomatic persons. Mayo Clin Proc 74:243–252PubMedCrossRef
21.
World Health Organization (2000) Obesity: preventing and managing the global epidemic. Report on a WHO Consultation. Technical Report Series, No 894. Geneva, WHO
22.
Schmermund A, Möhlenkamp S, Berenbein S et al (2006) Population-based assessment of subclinical coronary atherosclerosis using electron-beam computed tomography. Atherosclerosis 185:177–182PubMedCrossRef
23.
Bender R, Grouven U (1997) Ordinal logistic regression in medical research. J R Coll Physicians Lond 31:546–551PubMed
24.
Scott SC, Goldberg MS, Mayo NE (1997) Statistical assessment of ordinal outcomes in comparative studies. J Clin Epidemiol 50:45–55PubMedCrossRef
25.
Möhlenkamp S, Lehmann N, Schmermund A et al (2003) Prognostic value of extensive coronary calcium quantities in symptomatic males—a 5-year follow-up study. Eur Heart J 24:845–854PubMedCrossRef
26.
Vliegenthart R, Oudkerk M, Song B et al (2002) Coronary calcification detected by electron-beam computed tomography and myocardial infarction. The Rotterdam Coronary Calcification Study. Eur Heart J 23:1596–1603PubMedCrossRef
27.
Hoff JA, Daviglus ML, Chomka EV et al (2003) Conventional coronary artery disease risk factors and coronary artery calcium detected by electron beam tomography in 30,908 healthy individuals. Ann Epidemiol 13:163–169PubMedCrossRef
28.
Budoff MJ, Achenbach S, Blumenthal RS et al (2006) Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation 114:1761–1791PubMedCrossRef
29.
Erbel R, Möhlenkamp S, Kerkhoff G, Budde T, Schmermund A (2007) Non-invasive screening for coronary artery disease: calcium scoring. Heart 93:1620–1629PubMedCrossRef
30.
Hyltoft PP, Brandslund I, Jorgensen L et al (2001) Evaluation of systematic and random factors in measurements of fasting plasma glucose as the basis for analytical quality specifications in the diagnosis of diabetes. 3. Impact of the new WHO and ADA recommendations on diagnosis of diabetes mellitus. Scand J Clin Lab Invest 61:191–204CrossRef
31.
Nasir K, Santos R, Tufail K et al (2007) High-normal fasting blood glucose in non-diabetic range is associated with increased coronary artery calcium burden in asymptomatic men. Atherosclerosis 195:155–160CrossRef
32.
Meigs JB, Larson MG, D’Agostino RB et al (2002) Coronary artery calcification in type 2 diabetes and insulin resistance: the Framingham Offspring Study. Diabetes Care 25:1313–1319PubMedCrossRef
33.
Wagenknecht LE, D’Agostino RB, Haffner SM, Savage PJ, Rewers M (1998) Impaired glucose tolerance, type 2 diabetes, and carotid wall thickness: the Insulin Resistance Atherosclerosis Study. Diabetes Care 21:1812–1818PubMedCrossRef
34.
Haffner SM (1998) The importance of hyperglycemia in the nonfasting state to the development of cardiovascular disease. Endocr Rev 19:583–592PubMedCrossRef
35.
Faeh D, William J, Yerly P, Paccaud F, Bovet P (2007) Diabetes and pre-diabetes are associated with cardiovascular risk factors and carotid/femoral intima–media thickness independently of markers of insulin resistance and adiposity. Cardiovasc Diabetol 6:32. doi:10.​1186/​1475-2840-6-32 PubMedCrossRef
36.
Ohnishi H, Saitoh S, Takagi S et al (2003) Pulse wave velocity as an indicator of atherosclerosis in impaired fasting glucose: The Tanno and Sobetsu Study. Diabetes Care 26:437–440PubMedCrossRef
37.
Lee WL, Cheung AM, Cape D, Zinman B (2000) Impact of diabetes on coronary artery disease in women and men: a meta-analysis of prospective studies. Diabetes Care 23:962–968PubMedCrossRef
38.
Hoff JA, Quinn L, Sevrukov A et al (2003) The prevalence of coronary artery calcium among diabetic individuals without known coronary artery disease. J Am Coll Cardiol 41:1008–1012PubMedCrossRef
39.
Levitan EB, Song Y, Ford ES, Liu S (2004) Is nondiabetic hyperglycemia a risk factor for cardiovascular disease? A meta-analysis of prospective studies. Arch Intern Med 164:2147–2155PubMedCrossRef
40.
Sorkin JD, Muller DC, Fleg JL, Andres R (2005) The relation of fasting and 2-h postchallenge plasma glucose concentrations to mortality: data from the Baltimore Longitudinal Study of Aging with a critical review of the literature. Diabetes Care 28:2626–2632PubMedCrossRef
41.
Grundy SM (2006) Diabetes and coronary risk equivalency: what does it mean. Diabetes Care 29:457–460PubMedCrossRef
42.
Levitzky YS, Pencina MJ, D’Agostino RB et al (2008) Impact of impaired fasting glucose on cardiovascular disease: the Framingham Heart Study. J Am Coll Cardiol 51:264–270PubMedCrossRef
43.
44.
Williams JW, Zimmet PZ, Shaw JE et al (2003) Gender differences in the prevalence of impaired fasting glycaemia and impaired glucose tolerance in Mauritius. Does sex matter. Diabet Med 20:915–920PubMedCrossRef
45.
Bock G, Dalla Man C, Campioni M et al (2006) Pathogenesis of pre-diabetes: mechanisms of fasting and postprandial hyperglycemia in people with impaired fasting glucose and/or impaired glucose tolerance. Diabetes 55:3536–3549PubMedCrossRef
46.
Chobanian AV, Bakris GL, Black HR et al (2003) The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 289:2560–2572PubMedCrossRef
Metadata
Title
Association of impaired fasting glucose and coronary artery calcification as a marker of subclinical atherosclerosis in a population-based cohort—results of the Heinz Nixdorf Recall Study
Authors
S. Moebus
A. Stang
S. Möhlenkamp
N. Dragano
A. Schmermund
U. Slomiany
B. Hoffmann
M. Bauer
M. Broecker-Preuss
K. Mann
J. Siegrist
R. Erbel
K.-H. Jöckel
Heinz Nixdorf Recall Study Group
Publication date
01-01-2009
Publisher
Springer-Verlag
Published in
Diabetologia / Issue 1/2009
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI
https://doi.org/10.1007/s00125-008-1173-y

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