Association between glycosylated hemoglobin, left ventricular mass and aortic function in nondiabetic individuals with insulin resistance

Abstract

Objective: An association between glycosylated hemoglobin (GHb) and cardiovascular mortality in nondiabetic individuals has recently been reported. Prompt detection of nondiabetic individuals with high-normal GHb and early cardiovascular involvement may be of value for preventive strategies. In this investigation, a possible relationship between GHb, aortic function and left ventricular (LV) mass in nondiabetic individuals has been studied. Methods: A total of 263 nondiabetic African-Americans, aged 22-63 (mean 42G8) years were studied. All individuals were first degree relatives of diabetic patients, had normal oral glucose tolerance test (2-h OGTT) and decreased peripheral action of insulin. LV diameters and mass (echocardiography); ascending and abdominal aortic distensibility (echocardiography, arterial pressure); pulse wave velocity (PWV; electrocardiography, Doppler); fasting glucose; GHb; insulin sensitivity index (S I ) and 2-h OGTT were measured. Multiple linear and logistic regression analyses were used to identify significant independent associations of fasting glucose; GHb; S I and 2-h OGTT with aortic function and LV mass. Results: In fully adjusted multivariate logistic regression analysis, GHb predicted lower values of aortic distensibility (odds ratio (OR) 1.67 95% CI (1.04-2.75), PZ0.04); higher PWV (OR 1.79 95% CI (1.09-2.93), PZ0.022); and higher values of LV mass (OR 1.56 95% CI (1.08-2.88), PZ0.029). Fasting glucose, S I , and 2 h OGTT were not associated with aortic function and LV mass. Conclusion: Higher GHb concentrations, even within 'normal' range, are independently associated with stiffer aorta and increased LV mass and thus may detect nondiabetic individuals at increased cardiovascular risk.

Nondiabetic Glucometabolic Status and Progression of Aortic Stiffness: The Whitehall II Study

“…Importantly, this remained after adjustment for physiological confounders of stiffness such as MAP and heart rate (34). Similar results have been reported previously using a variety of study designs, indices of stiffness, and varying levels of adjustment for physiological confounders (11,15,16,35,36). In the current study, adjustment for other potential risk factors for arterial stiffening or cardiovascular disease only modestly reduced the strength of association with glucose measures, but the associations with HOMA-IR and HbA 1c were more markedly attenuated, with an approximate halving of the β-values.…”

“…In the current study, adjustment for other potential risk factors for arterial stiffening or cardiovascular disease only modestly reduced the strength of association with glucose measures, but the associations with HOMA-IR and HbA 1c were more markedly attenuated, with an approximate halving of the β-values. This contrasts with cross-sectional findings from a cohort of 263 African Americans (16), in whom HbA 1c but not fasting or 2-h glucose levels remained independently associated with cfPWV. This disparity possibly reflects ethnic differences in the association between HbA 1c and arterial stiffness or may reflect a lack of appropriate statistical power in the African American study.…”

“…Diabetes has been linked with increased vascular stiffness in several case-control studies (11–13), and HbA 1c level is associated with an accelerated age-related increase in cfPWV in individuals with type 2 diabetes (14). Cross-sectional studies in individuals without diabetes suggest an association between aortic stiffness, glycemia, and indices of insulin resistance (11,15,16). However, a prospective analysis using Whitehall II data are equivocal, finding associations only in men (17).…”

Associations Between Collagen Synthesis and Degradation and Aortic Function in Arterial Hypertension

“…LV mass and function were measured as described previously. 13 LV mass index was derived by dividing LV mass by body surface area. Individuals with LV mass >150 g/m 2 for men and >120 g/m 2 for women were considerate as having LV hypertrophy and excluded from the study.…”

Haemoglobin A1c levels and subsequent cardiovascular disease in persons without diabetes: a meta-analysis of prospective cohorts

“…After reading the full text, there were 26 potentially acceptable studies that were rejected at the final stage: 14 did not have appropriate data [1,[13][14][15][16][17][18][19][20][21][22][23][24][25]; four did not involve outcomes of interest [26][27][28][29]; three studied non-relevant populations [30][31][32]; three were duplicates [33][34][35]; and two were editorials/review papers [36,37]. That left seven papers for analysis [38][39][40][41][42][43][44].…”