Korean J Health Promot.  2015 Jun;15(2):47-53. 10.15384/kjhp.2015.15.2.47.

The Correlation between Hemoglobin A1c and Common Carotid Artery Intima Medial Thickness of Both Genders with Less Than 6.5% HbA1c Based on Ultrasound Measurement

• Ryu Y
• Park Y
• Ye BJ

• KMID: 2247072
• DOI: http://doi.org/10.15384/kjhp.2015.15.2.47

Abstract

BACKGROUND
The glycemic control in diabetes is well known to arouse a medical risk of macrovascular regions. This study aimed for exploring the relationship between carotid artery intima media thickness (IMT) and the risk triggers of macrovascular diseases in the group of glycated hemoglobin value less than 6.5%.
METHODS
The subjects were made of 336 health-check examinees in a university hospital and tested by glycated hemoglobin (HbA1c) including ultrasound application on carotid artery IMT to be measured. The relationship between values of HbA1c and carotid artery IMT was reviewed by use of Pearson's correlation, and then influential causes on the carotid artery IMT were analyzed with multiple linear regression models.
RESULTS
Elements like age and fasting plasma glucose were associated with the carotid artery IMT in both men and women. HbA1c, C-reactive protein (CRP) in men and waist to hip ratio (WHR), high-density lipoprotein (HDL)-cholesterol in women showed statistically significant association with the carotid artery IMT. Age and HbA1c were recognized as variables affecting on the carotid artery IMT in men, in contrast, age was only a significant affecting factor in women with regarding various considerations such as fasting plasma glucose, CRP, HDL, WHR and smoking.
CONCLUSIONS
Our clinical investigation revealed that HbA1c was associated with the carotid artery IMT in normal and pre-diabetes with HbA1c less than 6.5%. The outcome might suggest preliminary glucose control be monitored and managed in order to detect and regulate the impairment of macrovascular diseases prior to the occurrence of diabetes.

Keyword

Hemoglobin A1c; Carotid arteries; Carotid intima-media thickness; Diabetes mellitus

MeSH Terms

Blood Glucose
C-Reactive Protein
Carotid Arteries
Carotid Artery, Common*
Carotid Intima-Media Thickness
Diabetes Mellitus
Fasting
Female
Glucose
Hemoglobin A, Glycosylated
Humans
Linear Models
Lipoproteins
Male
Smoke
Smoking
Ultrasonography*
Waist-Hip Ratio
C-Reactive Protein
Glucose
Lipoproteins
Smoke

Reference

1.Lee YS., Moon SS. The use of HbA 1c for diagnosis of type 2 diabetes in Korea. Korean J Med. 2011. 80(3):291–7.

2.Singer DE., Nathan DM., Anderson KM., Wilson PW., Evans JC. Association of HbA1c with prevalent cardiovascular disease in the original cohort of the Framingham Heart Study. Diabetes. 1992. 41(2):202–8.

3.Park S., Barrett-Connor E., Wingard DL., Shan J., Edelstein S. GHb is a better predictor of cardiovascular disease than fasting or postchallenge plasma glucose in women without diabetes. The Rancho Bernardo Study. Diabetes Care. 1996. 19(5):450–6.

4.Fuller JH., Shipley MJ., Rose G., Jarrett RJ., Keen H. Coronary-heart-disease risk and impaired glucose tolerance. The Whitehall study. Lancet. 1980. 1(8183):1373–6.

5.Charles MA., Fontbonne A., Thibult N., Warnet JM., Rosselin GE., Eschwege E. Risk factors for NIDDM in white population. Paris prospective study. Diabetes. 1991. 40(7):796–9.

6.Rodriguez BL., Curb JD., Burchfiel CM., Huang B., Sharp DS., Lu GY, et al. Impaired glucose tolerance, diabetes, and cardiovascular disease risk factor profiles in the elderly. The Honolulu Heart Program. Diabetes Care. 1996. 19(6):587–90.

7.Kim SK., Kim DJ., Kim SH., Kim HJ., Rhee YM., Kim HD, et al. The role of impaired fasting glucose on carotid artery intima media thickness as risk factor for atherosclerosis. J Korean Diabetes. 2002. 3(2):164–76.

8.Hanefeld M., Temelkova-Kurktschiev T., Schaper F., Henkel E., Siegert G., Koehler C. Impaired fasting glucose is not a risk factor for atherosclerosis. Diabet Med. 1999. 16(3):212–8.

9.International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009. 32(7):1327–34.

10.Saudek CD., Herman WH., Sacks DB., Bergenstal RM., Edelman D., Davidson MB. A new look at screening and diagnosing diabetes mellitus. J Clin Endocrinol Metab. 2008. 93(7):2447–53.

11.Bennett CM., Guo M., Dharmage SC. HbA(1c) as a screening tool for detection of Type 2 diabetes: a systematic review. Diabet Med. 2007. 24(4):333–43.

12.American Diabetes Association. Standards of medical care in diabetes--2010. Diabetes Care. 2010. 33(Suppl 1):S11–61.

13.Selvin E., Steffes MW., Zhu H., Matsushita K., Wagenknecht L., Pankow J, et al. Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults. N Engl J Med. 2010. 362(9):800–11.

14.Pignoli P., Tremoli E., Poli A., Oreste P., Paoletti R. Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation. 1986. 74(6):1399–406.

15.Wong M., Edelstein J., Wollman J., Bond MG. Ultrasonic-pathological comparison of the human arterial wall. Verification of intima-media thickness. Arterioscler Thromb. 1993. 13(4):482–6.

16.Chambless LE., Heiss G., Folsom AR., Rosamond W., Szklo M., Sharrett AR, et al. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987-1993. Am J Epidemiol. 1997. 146(6):483–94.

17.Bots ML., Hoes AW., Koudstaal PJ., Hofman A., Grobbee DE. Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study. Circulation. 1997. 96(5):1432–7.

18.O'Leary DH., Polak JF., Kronmal RA., Manolio TA., Burke GL., Wolfson SK Jr. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999. 340(1):14–22.

19.Nishida C., Ko GT., Kumanyika S. Body fat distribution and noncommunicable diseases in populations: overview of the 2008 WHO Expert Consultation on Waist Circumference and Waist-Hip Ratio. Eur J Clin Nutr. 2010. 64(1):2–5.

20.Salonen R., Salonen JT. Progression of carotid atherosclerosis and its determinants: a population-based ultrasonography study. Atherosclerosis. 1990. 81(1):33–40.

21.Ko SH., Kim SR., Kim DJ., Oh SJ., Lee HJ., Shim KH, et al. 2011 clinical practice guidelines for type 2 diabetes in Korea. Diabetes Metab J. 2011. 35(5):431–6.

22.Turner RC., Millns H., Neil HA., Stratton IM., Manley SE., Matthews DR, et al. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS: 23). BMJ. 1998. 316(7134):823–8.

23.Laakso M. Glycemic control and the risk for coronary heart disease in patients with non-insulin-dependent diabetes mellitus. The Finnish studies. Ann Intern Med. 1996. 124(1 Pt 2):127–30.

24.Jensen-Urstad KJ., Reichard PG., Rosfors JS., Lindblad LE., Jensen-Urstad MT. Early atherosclerosis is retarded by improved long-term blood glucose control in patients with IDDM. Diabetes. 1996. 45(9):1253–8.

25.Cho YL., Kim DJ., Kim HD., Choi SH., Kim SK., Kim HJ, et al. Reference values of carotid artery intima-media thickness and association with atherosclerotic risk factors in healthy subjects in Korea. Korean J Med. 2003. 64(3):275–83.

26.Jotkowitz AB., Mark Clarfield A., Faust G., Wartman SA. Screening for carotid artery disease in the general public. Eur J Intern Med. 2005. 16(1):34–6.

27.Gaitini D., Soudack M. Diagnosing carotid stenosis by Doppler sonography: state of the art. J Ultrasound Med. 2005. 24(8):1127–36.

28.Kim YJ. Carotid ultrasonography; B-mode imaging. Korean J Stroke. 2008. 10(2):106–10.

29.Zhao B., Liu Y., Zhang Y., Chen Y., Yang Z., Zhu Y, et al. Gender difference in carotid intima-media thickness in type 2 diabetic patients: a 4-year follow-up study. Cardiovasc Diabetol. 2012. 11:51.

30.Doruk H., Mas MR., Ateşkan U., Isik AT., Sağlam M., Kutlu M. The relationship between age and carotid artery intima-media thickness, hemoglobin A1c in nondiabetic, healthy geriatric population. Arch Gerontol Geriatr. 2005. 41(2):113–9.