Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MA (J.B.E.-T., R.R.K., S.H.G.).
Department of Biostatistical Sciences (H.C., S.S.), Wake Forest University School of Medicine, Winston-Salem, NC.
Circ Cardiovasc Imaging. 2019 Mar;12(3):e008641. doi: 10.1161/CIRCIMAGING.118.008641.
Background We investigated the associations of glycemic markers (HbA [hemoglobin A], fasting plasma glucose, and insulin resistance-homeostasis model assessment of insulin resistance) with subclinical cardiovascular disease (CVD) among blacks. Methods We included 4303 community-dwelling blacks (64% women; mean age, 54.5 years) without prevalent CVD. Subclinical CVD was defined as ≥1 of the following: any coronary artery calcification (CAC), elevated carotid intima-media thickness (cIMT), left ventricular (LV) hypertrophy, LV ejection fraction <50%, and peripheral artery disease (ankle-brachial index, <0.90). Estimates of cross-sectional associations of glycemic markers (fasting plasma glucose, HbA, and homeostasis model assessment of insulin resistance) with subclinical CVD measures were adjusted for traditional CVD risk factors. Results Each 1% increment in HbA was associated with higher odds of CAC, abnormal cIMT, and subclinical CVD (all P <0.001). Adjusted mean values of LV mass (LVM), LVM index, relative wall thickness, CAC, and cIMT were increasingly abnormal with worsening HbA categories (all P<0.05). Each 10-mg/dL increase in fasting plasma glucose was associated with higher odds of LV hypertrophy, CAC, abnormal cIMT, and subclinical CVD (all P <0.005). Adjusted mean values of LVM, LVM index, relative wall thickness, CAC, ankle-brachial index, and cIMT were more abnormal across categories of worsening fasting plasma glucose (all P <0.05). Each unit increment in log-transformed homeostasis model assessment of insulin resistance conferred a higher odd of having LV hypertrophy ( P<0.01). Across quartiles of homeostasis model assessment of insulin resistance, we observed progressively abnormal adjusted mean values of LVM, LVM index, relative wall thickness, and ankle-brachial index (all P <0.01). Conclusions Among blacks, glycemic markers were differentially associated with various measures of subclinical CVD.
背景 我们研究了血糖标志物（HbA[血红蛋白 A]、空腹血浆葡萄糖和胰岛素抵抗-稳态模型评估的胰岛素抵抗）与黑人亚临床心血管疾病（CVD）之间的关联。
方法 我们纳入了 4303 名无明显 CVD 的社区居住黑人（64%为女性；平均年龄 54.5 岁）。亚临床 CVD 定义为以下任何一项：任何冠状动脉钙化（CAC）、颈动脉内膜中层厚度（cIMT）升高、左心室（LV）肥大、LV 射血分数 <50%和外周动脉疾病（踝臂指数，<0.90）。血糖标志物（空腹血浆葡萄糖、HbA 和稳态模型评估的胰岛素抵抗）与亚临床 CVD 测量的横断面关联估计值经过传统 CVD 风险因素的调整。
结果 每增加 1%的 HbA 与 CAC、异常 cIMT 和亚临床 CVD 的几率增加相关（均 P<0.001）。随着 HbA 分类恶化，LV 质量（LVM）、LVM 指数、相对壁厚度、CAC 和 cIMT 的平均调整值逐渐异常（均 P<0.05）。空腹血浆葡萄糖每增加 10mg/dL，与 LV 肥大、CAC、异常 cIMT 和亚临床 CVD 的几率增加相关（均 P<0.005）。随着空腹血浆葡萄糖恶化程度的分类，LVM、LVM 指数、相对壁厚度、CAC、踝臂指数和 cIMT 的平均调整值更加异常（均 P<0.05）。对数转换的稳态模型评估的胰岛素抵抗每增加一个单位，LV 肥大的几率就会增加（P<0.01）。在稳态模型评估的胰岛素抵抗四分位数中，我们观察到 LVM、LVM 指数、相对壁厚度和踝臂指数的平均调整值逐渐异常（均 P<0.01）。
结论 在黑人中，血糖标志物与亚临床 CVD 的各种测量指标有差异关联。
