Association between the Plasma-Glycosylated Hemoglobin A1c/High-Density Lipoprotein Cholesterol Ratio and Carotid Atherosclerosis: A Retrospective Study

Abstract

Background. Diabetes mellitus (DM) and dyslipidemia are the main risk factors for atherosclerosis. Elevated glycosylated hemoglobin A1c (HbA1c) and reduced high-density lipoprotein cholesterol (HDL-C) are associated with the progression of atherosclerosis. The aim of this study is at exploring the relationship between the HbA1c/HDL-C ratio and atherosclerosis evaluated using carotid artery intima-media thickness (cIMT) and carotid artery plaque. Methods. In this retrospective study, we enrolled 1304 patients who had multiple cardiovascular risk factors or symptoms of suspected coronary artery disease. cIMT and carotid artery plaque were measured using ultrasonography. Logistic regression was used to explore the correlation between the HbA1c/HDL-C ratio and cIMT or carotid artery plaque. We used restricted cubic spline curves to assess nonlinear relationships between the HbA1c/HDL-C ratio and cIMT or carotid artery plaque. Results. With increased quartiles of HbA1c/HDL-C, patients had higher cIMT and a greater carotid plaque burden. After adjusting for other relevant clinical covariates, patients with the highest HbA1c/HDL-C ratio (quartile 4 (Q4)) had a 2.88 times (95% confidence interval (CI): 2.02–4.10, P < 0.001 ) more abnormal mean cIMT, 3.72 times (95% CI: 2.55–5.44, P < 0.001 ) more abnormal maximum cIMT, and 2.58 times (95% CI: 1.70–3.91, P < 0.001 ) greater carotid artery plaque burden compared with patients who had the lowest HbA1c/HDL-C ratio (Q1). Moreover, the association of HbA1c/HDL-C with atherosclerosis remained significant in a subsample of patients with and without DM. Conclusion. As a novel compound indicator for evaluating blood glucose homeostasis and dyslipidemia, the HbA1c/HDL-C ratio was positively correlated with carotid atherosclerosis evaluated using the mean and maximum cIMT as well as the carotid artery plaque burden.

Prevalence and factors associated with carotid atherosclerosis in a Malagasy population with Type 2 diabetes mellitus: A cross‐sectional retrospective study

“…Even if no significant association was not objectified in the present study, hypertension and dyslipidemia remain the main cardiovascular risk factors most associated with diabetes as in the literature 29 . Moreover, other authors had shown that these risk factors were significantly associated with carotid atherosclerosis 20,31 . Since, these are pathological conditions that aggravate the development and progression of atherosclerotic lesions 32 .…”

Risk Factors for Ankle Brachial Index and Carotid Artery Stenosis in Patients with Type 2 Diabetes

“…Obesity increases systemic inflammation and leads to atherosclerosis. A high correlation between subclinical atherosclerosis and hemoglobin A1c and the duration of diabetes affects plaques and the stenosis of coronary arteries, the atherosclerosis of carotid arteries, and ABI [ 41 ]. The progression of atherosclerosis in the carotid and coronary arteries is aggravated by hyperglycemia [ 42 ].…”

Serum LDL-C/HDL-C ratio and the risk of carotid plaques: a longitudinal study

“…Older age and diabetes mellitus are known risk factors for carotid plaque formation and atherosclerosis [ 38 , 39 ]. The metabolic disorders that accompany diabetes, such as chronic hyperglycemia, dyslipidemia, and insulin resistance, lead to impaired function of vascular endothelial cells, smooth muscle cells, and platelets, which predisposes patients to carotid plaques [ 40 – 42 ]. Researchers have reported a higher prevalence and incidence of carotid plaques in men than in women [ 30 ].…”