Age-specific difference in the association between prediabetes and subclinical atherosclerosis: an analysis of a chinese prospective cohort study

Abstract

Background Prediabetes is an important risk factor of cardiovascular disease (CVD) and is associated with subclinical atherosclerosis. However, the evidence of prediabetes as a cardiovascular risk factor is mainly derived from middle-aged adults. Recently, multiple studies supported that prediabetes in older adults would not lead to higher risk of CVD or mortality. We aimed to investigate the age-specific difference in the association between prediabetes and subclinical atherosclerosis in a Chinese prospective cohort study. Methods We included 4739 individuals aged ≥ 40 years and without diagnosed diabetes or CVD history, and divided them into middle-aged adults (age < 60) and older adults (age ≥ 60). Fasting plasma glucose (FPG), 2-h post-load plasma glucose (2 h-PPG) and glycated hemoglobin (HbA1c) were measured at baseline to identify prediabetes status. At follow-up visits, subclinical atherosclerosis status was assessed by branchial-ankle pulse wave velocity (baPWV) and carotid intima-media thickness (CIMT). Logistic regression analysis, restricted cubic splines and cross-lagged path analysis were used in statistical analysis. Results 1634 participants aged over 60 years, and 64.3% of them had prediabetes. 3105 participants aged 40–59 years, and 49.3% of them had prediabetes. We found that prediabetes was associated with increased risk of subclinical atherosclerosis in middle-aged adults, but the association attenuated substantially in older adults. Impaired glucose tolerance (IGT), compared to normal glucose tolerance, was associated with 39% lower risk of increased baPWV only in older adults. In accordance, the association between 2 h-PPG and risk of increased baPWV was “U-shaped” in older adults, while risk of elevated baPWV increased linearly with 2 h-PPG in middle-aged adults. In the cross-lagged analysis, increase in FPG and 2 h-PPG tended not to precede increase in baPWV in older adults, but appeared to increase simultaneously with baPWV in middle-aged ones. Conclusion Our results indicated that prediabetes might be less related to subclinical atherosclerosis in older adults than in middle-aged adults and suggested that age was important to consider in the care of adults with prediabetes.

Association of combined healthy lifestyle with risk of adverse outcomes in patients with prediabetes

“…Fortunately, our results suggest that strict adherence to a healthy lifestyle could effectively reduce the poor prognosis of women with prediabetes. In addition, a Chinese prospective cohort study indicated that the incidence of prediabetes in people more than 60 years old (64.3%) was significantly higher than that in people 40–59 years old (49.3%), but the younger group faced a higher risk of prediabetes combined with atherosclerosis, which could be improved by healthy lifestyle habits in our study 48 …”

“…In addition, a Chinese prospective cohort study indicated that the incidence of prediabetes in people more than 60 years old (64.3%) was significantly higher than that in people 40-59 years old (49.3%), but the younger group faced a higher risk of prediabetes combined with atherosclerosis, which could be improved by healthy lifestyle habits in our study. 48 The strengths of our study include a large sample size, prospective community-based cohort with a long-term follow-up, and abundant data resources. This enabled us to conduct in-depth analyses of the risk of multiple adverse outcomes, including T2DM, CVD, and CKD risk associated with prediabetes and a wide combination of traditional and emerging lifestyle factors.…”

Long-term High Level of Insulin Resistance Increase the Prevalence of Coronary Artery Calcification: the CARDIA study

“…These changes are the most common mechanism of vascular calci cation. Additionally, temporary hyperglycemia may induce osteogenesis and alkaline phosphatase activation in vascular smooth muscle cells [31], it was shown previously that under high phosphorus conditions, exosomes from endothelial cells caused calci cation of vascular smooth muscle cells, and eventually lead to CAC [32]. There were several important signi cances in our research for youths' cardiovascular protection.…”

Sex differences in the risk of arterial stiffness among adults with different glycemic status and modifications by age

“…Fourth, the determination of glucose levels was conducted only once and misclassification of glycemic status may exist. In addition, associations between prediabetes and arterial stiffness may depend on the glucose parameter that is elevated, 43 , 44 , 45 but types of prediabetes (ie, impaired fasting glucose, impaired glucose tolerance, or elevated HbA1c) were not specified owing to a limited number of cases. Because insulin resistance and low‐grade inflammation, which often coexist with prediabetes, are risk factors leading to atherosclerosis, 46 , 47 , 48 analyses in participants with and without insulin resistance provided additional insights.…”