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High-normal fasting blood glucose in non-diabetic range is associated with increased coronary artery calcium burden in asymptomatic men

      Abstract

      Objective

      : The objective of the study is to evaluate whether high fasting blood glucose (FBG) in the non-diabetic range (<126 mg/dl) is associated with subclinical coronary atherosclerosis as determined by coronary artery calcium (CAC) independent of clustering of metabolic syndrome (MS) risk factors.

      Methods & results

      : Previously non-diabetic, 458 asymptomatic non-diabetic Brazilian men (mean age: 46 ± 7 years, range: 29–65) underwent clinical consultation including FBG measurements and electron-beam tomography (EBT). The mean FBG of the study population was 88 ± 10 mg/dl. Overall, 190 (42%) of men had CAC > 0. The prevalence of CAC was significantly higher among men with high-normal FBG (4th quartile: 94–125 mg/dl) versus normal FBG group (lower three quartiles: 66–93 mg/dl) (62% versus 35%, p < 0.0001). In age adjusted analyses the odds ratio (OR) for any CAC among men with high-normal FBG versus normal FBG was 2.19 (95% CI: 1.33–3.58). On further adjustment for risk factors the relationship was slightly attenuated, however remained statistically significant (OR = 1.78, 95% CI 1.05–3.00, p = 0.03). In sub-stratified analyses high-normal FBG was associated with CAC among men without MS (OR: 1.99, 95% CI: 1.04–3.78) and with MS (OR: 2.12, 95% CI: 0.95–4.80). Similar relations with high-normal FBG were observed among individuals classified low risk (OR: 2.34, 95% CI: 1.14–4.83) as well intermediate high-risk men (OR: 1.95, 95% CI: 0.99–3.86) by Framingham risk score (FRS), respectively.

      Conclusions

      : Fasting blood glucose in the upper normal range appears to be associated with the presence of CAC in apparently non-diabetic Brazilian men.

      Keywords

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      References

        • Kannel W.B.
        • McGee D.L.
        Diabetes and cardiovascular disease: the Framingham Study.
        JAMA. 1979; 241: 2035-2038
        • Haffner S.M.
        • Lehto S.
        • Ronnemaa T.
        • Pyorala K.
        • Laakso M.
        Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction.
        N Engl J Med. 1998; 339: 229-234
        • Hoff J.A.
        • Quinn L.
        • Sevrukov A.
        • et al.
        The prevalence of coronary artery calcium among diabetic individuals without known coronary artery disease.
        J Am Coll Cardiol. 2003; 41: 1008-1012
        • Meigs J.B.
        • Larson M.G.
        • D’Agostino R.B.
        • et al.
        Coronary artery calcification in type 2 diabetes and insulin resistance: the Framingham offspring study.
        Diab Care. 2002; 25: 1313-1319
        • Coutinho M.
        • Gerstein H.C.
        • Wang Y.
        • Yusuf S.
        The relationship between glucose and incident cardiovascular events. A metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years.
        Diab Care. 1999; 22: 233-240
        • Bjornholt J.V.
        • Erikssen G.
        • Aaser E.
        • et al.
        Fasting blood glucose: an underestimated risk factor for cardiovascular death. Results from a 22-year follow-up of healthy nondiabetic men.
        Diab Care. 1999; 22: 45-49
        • Bonora E.
        • Kiechl S.
        • Willeit J.
        • et al.
        Plasma glucose within the normal range is not associated with carotid atherosclerosis: prospective results in subjects with normal glucose tolerance from the Bruneck Study.
        Diab Care. 1999; 22: 1339-1346
        • Thomas G.N.
        • Chook P.
        • Qiao M.
        • et al.
        Deleterious impact of “high normal” glucose levels and other metabolic syndrome components on arterial endothelial function and intima-media thickness in apparently healthy Chinese subjects: The CATHAY Study.
        Arterioscler Thromb Vasc Biol. 2004; 24: 739-743
        • Grundy S.M.
        • Pasternak R.
        • Greenland P.
        • Smith Jr., S.
        • Fuster V.
        Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations: a statement for healthcare professionals from the American Heart Association and the American College of Cardiology.
        Circulation. 1999; 100: 1481-1492
        • Grundy S.M.
        • Pasternak R.
        • Greenland P.
        • Smith Jr., S.
        • Fuster V.
        AHA/ACC scientific statement: assessment of cardiovascular risk by use of multiple-risk-factor assessment equations—a statement for healthcare professionals from the American Heart Association and the American College of Cardiology.
        J Am Coll Cardiol. 1999; 34: 1348-1359
        • Rumberger J.A.
        • Simons D.B.
        • Fitzpatrick L.A.
        • Sheedy P.F.
        • Schwartz R.S.
        Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study.
        Circulation. 1995; 92: 2157-2162
        • Raggi P.
        • Callister T.Q.
        • Cooil B.
        • et al.
        Identification of patients at increased risk of first unheralded acute myocardial infarction by electron-beam computed tomography.
        Circulation. 2000; 101: 850-855
        • Arad Y.
        • Spadaro L.A.
        • Goodman K.
        • Newstein D.
        • Guerci A.D.
        Prediction of coronary events with electron beam computed tomography.
        J Am Coll Cardiol. 2000; 36: 1253-1260
        • Agatston A.S.
        • Janowitz W.R.
        • Hildner F.J.
        • et al.
        Quantification of coronary artery calcium using ultrafast computed tomography.
        J Am Coll Cardiol. 1990; 15: 827-832
        • Arad Y.
        • Newstein D.
        • Cadet F.
        • Roth M.
        • Guerci A.D.
        Association of multiple risk factors and insulin resistance with increased prevalence of asymptomatic coronary artery disease by an electron-beam computed tomographic study.
        Arterioscler Thromb Vasc Biol. 2001; 21: 2051-2058
        • Kuller L.H.
        • Velentgas P.
        • Barzilay J.
        • et al.
        Diabetes mellitus: subclinical cardiovascular disease and risk of incident cardiovascular disease and all-cause mortality.
        Arterioscler Thromb Vasc Biol. 2000; 20: 823-829
        • Barzilay J.I.
        • Spiekerman C.F.
        • Kuller L.H.
        • et al.
        Cardiovascular Health Study. Prevalence of clinical and isolated subclinical cardiovascular disease in older adults with glucose disorders: the Cardiovascular Health Study.
        Diab Care. 2001; 24: 1233-1239
        • Wagenknecht L.E.
        • D’Agostino Jr., R.B.
        • Haffner S.M.
        • Savage P.J.
        • Rewers M.
        Impaired glucose tolerance, type 2 diabetes, and carotid wall thickness: the Insulin Resistance Atherosclerosis Study.
        Diab Care. 1998; 21: 1812-1818
        • Fuller J.H.
        • Shipley M.J.
        • Rose G.
        • Jarrett R.J.
        • Keen H.
        Coronary-heart-disease risk and impaired glucose tolerance. The Whitehall study.
        Lancet. 1980; 28: 1373-1376
        • Yarnell J.W.
        • Patterson C.C.
        • Thomas H.F.
        • Sweetnam P.M.
        Fasting plasma glucose and subsequent macrovascular disease after 10 years follow-up: a collaborative study on two populations.
        QJM. 1999; 92: 207-210
        • Fisman E.Z.
        • Motro M.
        • Tenenbaum A.
        • et al.
        Impaired fasting glucose concentrations in nondiabetic patients with ischemic heart disease: a marker for a worse prognosis.
        Am Heart J. 2001; 141: 485-490
        • Muhlestein J.B.
        • Anderson J.L.
        • Horne B.D.
        • et al.
        Effect of fasting glucose levels on mortality rate in patients with and without diabetes mellitus and coronary artery disease undergoing percutaneous coronary intervention.
        Am Heart J. 2003; 146: 351-358
        • Gerstein H.C.
        • Pais P.
        • Pogue J.
        • Yusuf S.
        Relationship of glucose and insulin levels to the risk of myocardial infarction: a case-control study.
        J Am Coll Cardiol. 1999; 33: 612-619
        • American Diabetes Association
        Diagnosis and classification of diabetes mellitus.
        Diab Care. 2004; 27: S5-S10
        • Warram J.H.
        • Manson J.E.
        • Krolewski A.S.
        Glycosylated hemoglobin and the risk of retinopathy in insulin-dependent diabetes mellitus.
        N Engl J Med. 1995; 332: 1305-1306
        • Gerstein H.C.
        Is glucose a continuous risk factor for cardiovascular mortality?.
        Diab Care. 1999; 22: 659-660
        • Moss S.E.
        • Klein R.
        • Klein B.E.
        • Meuer S.M.
        The association of glycemia and cause-specific mortality in a diabetic population.
        Arch Intern Med. 1994; 154: 2473-2479
        • Andersson D.K.
        • Svardsudd K.
        Long-term glycemic control relates to mortality in type II diabetes.
        Diab Care. 1995; 18: 1534-1543
        • Giugliano D.
        • Ceriello A.
        • Paolisso G.
        Oxidative stress and diabetic vascular complications.
        Diab Care. 1996; 19: 257-267
        • Ford E.S.
        Body mass index, diabetes, and C-reactive protein among U.S. adults.
        Diab Care. 1999; 22: 1971-1977
        • Lyons T.J.
        Lipoprotein glycation and its metabolic consequences.
        Diabetes. 1992; 41: 67-73
        • Hoff J.A.
        • Daviglus M.L.
        • Chomka E.V.
        • et al.
        Conventional coronary artery disease risk factors and coronary artery calcium detected by electron beam tomography in 30,908 healthy individuals.
        Ann Epidemiol. 2003; 13: 163-169
        • The DECODE-Study Group, The European Diabetes Epidemiology Group
        Is fasting glucose sufficient to define diabetes? Epidemiological data from 20 European studies: diabetes epidemiology—collaborative analysis of diagnostic criteria in Europe.
        Diabetologia. 1999; 42: 647-654
        • DECODE Study Group, The European Diabetes Epidemiology Group
        Glucose tolerance and cardiovascular mortality: comparison of fasting and 2-hour diagnostic criteria.
        Arch Intern Med. 2001; 161: 397-405
        • Gerstein H.C.
        Fasting versus postload glucose levels: why the controversy?.
        Diab Care. 2001; 24: 1855-1857
        • Vlassara H.
        • Bucala R.
        • Striker L.
        Pathogenic effects of advanced glycosylation: biochemical, biologic, and clinical implications for diabetes and aging.
        Lab Invest. 1994; 70: 138-151
        • Everhart J.E.
        • Pettitt D.J.
        • Knowler W.C.
        • Rose F.A.
        • Bennett P.H.
        Medial arterial calcification and its association with mortality and complications of diabetes.
        Diabetologia. 1988; 31: 16-23
        • Raggi P.
        • Shaw L.J.
        • Berman D.S.
        • Callister T.Q.
        Prognostic value of coronary calcium screening in diabetic and non-diabetic individuals.
        J Am Coll Cardiol. 2004; 43: 1663-1669