Diabetes and pre-diabetes are associated with cardiovascular risk factors and carotid/femoral intima-media thickness independently of markers of insulin resistance and adiposity
Open Access
- 24 October 2007
- journal article
- research article
- Published by Springer Science and Business Media LLC in Cardiovascular Diabetology
- Vol. 6 (1), 32
- https://doi.org/10.1186/1475-2840-6-32
Abstract
Background Impaired glucose regulation (IGR) is associated with detrimental cardiovascular outcomes such as cardiovascular disease risk factors (CVD risk factors) or intima-media thickness (IMT). Our aim was to examine whether these associations are mediated by body mass index (BMI), waist circumference (waist) or fasting serum insulin (insulin) in a population in the African region. Methods Major CVD risk factors (systolic blood pressure, smoking, LDL-cholesterol, HDL-cholesterol,) were measured in a random sample of adults aged 25–64 in the Seychelles (n = 1255, participation rate: 80.2%). According to the criteria of the American Diabetes Association, IGR was divided in four ordered categories: 1) normal fasting glucose (NFG), 2) impaired fasting glucose (IFG) and normal glucose tolerance (IFG/NGT), 3) IFG and impaired glucose tolerance (IFG/IGT), and 4) diabetes mellitus (DM). Carotid and femoral IMT was assessed by ultrasound (n = 496). Results Age-adjusted levels of the major CVD risk factors worsened gradually across IGR categories (NFG < IFG/NGT < IFG/IGT < DM), particularly HDL-cholesterol and blood pressure (p for trend < 0.001). These relationships were marginally attenuated upon further adjustment for waist, BMI or insulin (whether considered alone or combined) and most of these relationships remained significant. With regards to IMT, the association was null with IFG/NGT, weak with IFG/IGT and stronger with DM (all more markedly at femoral than carotid levels). The associations between IMT and IFG/IGT or DM (adjusted by age and major CVD risk factors) decreased only marginally upon further adjustment for BMI, waist or insulin. Further adjustment for family history of diabetes did not alter the results. Conclusion We found graded relationships between IGR categories and both major CVD risk factors and carotid/femoral IMT. These relationships were only partly accounted for by BMI, waist and insulin. This suggests that increased CVD-risk associated with IGR is also mediated by factors other than the considered markers of adiposity and insulin resistance. The results also imply that IGR and associated major CVD risk factors should be systematically screened and appropriately managed.Keywords
This publication has 51 references indexed in Scilit:
- Prevalence, awareness and control of diabetes in the Seychelles and relationship with excess body weightBMC Public Health, 2007
- Role of Insulin Resistance and Hyperglycemia in the Development of AtherosclerosisThe American Journal of Cardiology, 2007
- Inflammation and metabolic disordersNature, 2006
- Association of Carotid Intima-Media Thickness With Angiographic Severity and Extent of Coronary Artery DiseaseThe American Journal of Cardiology, 2006
- Prediction of Cardiovascular Morbidity and MortalityStroke, 2006
- Hyperglycaemia after glucose loading is a major predictor of preclinical atherosclerosis in nondiabetic subjectsClinical Endocrinology, 2006
- Inflammation in the Prediabetic State Is Related to Increased Insulin Resistance Rather Than Decreased Insulin SecretionCirculation, 2003
- The Significance of Impaired Fasting Glucose Versus Impaired Glucose ToleranceDiabetes Care, 2003
- Post‐challenge hyperglycaemia relates more strongly than fasting hyperglycaemia with carotid intima‐media thickness: the RIAD StudyDiabetic Medicine, 2000
- Effects of Hemipancreatectomy on Insulin Secretion and Glucose Tolerance in Healthy HumansThe New England Journal of Medicine, 1990