Estimating the extent of subclinical arteriosclerosis of persons with prediabetes and diabetes mellitus among Japanese urban workers and their families: a cross-sectional study

Abstract

BackgroundDiabetes mellitus (hereafter called diabetes) is considered to accelerate arteriosclerosis leading to coronary heart disease and stroke. Thus, it is important to quantitatively estimate the extent of subclinical arteriosclerosis. A new method called cardio-ankle vascular index (CAVI) is developed to reflect arterial stiffness independently from blood pressure at the time of measurement. Then, we examined if CAVI scores could discriminate the extent of arteriosclerosis between persons with prediabetes (or borderline diabetes) and with diabetes among Japanese urban workers and their families.MethodsSubjects were 9881 men and 12033 women of company employees and their families who participated in cardiovascular disease screening in Japan. Persons having diabetes and prediabetes were defined based on the criteria set by American Diabetes Association. CAVI scores were measured by VaSera VS-1000. We applied the established age-sex specific cutoff points of CAVI scores above which were determined to be abnormally high or advanced level of arteriosclerosis. To examine the association of prediabetes and diabetes with CAVI scores, CAVI scores of screening participants were converted to a binary variable: 1 for less than cutoff points and 2 for equal or greater than cutoff points or abnormally high CAVI scores. Logistic regression method was used to examine the association of prediabetes and diabetes with CAVI scores after adjusting for major cardiovascular disease (CVD) risk factors.ResultsPrevalence of abnormally high CAVI scores was significantly higher after 40 years of age among persons with diabetes than either among persons with prediabetes or among normal persons in both genders. Significantly elevated odds ratios (ORs) of abnormally high CAVI scores appeared among persons with prediabetes: 1.29 (95 % confidence interval (CI), 1.11-1.48) for men and 1.14 (CI, 1.01-1.28) for women, and among persons with diabetes: 2.41 (CI, 1.97-2.95) for men and 2.52 (CI, 1.94-3.28) for women.ConclusionsThe extent of subclinical arteriosclerosis (including arterial stiffness and atherosclerosis) was moderately enhanced among persons with prediabetes and was further advanced among persons with diabetes. Thus, it is important to introduce earlier interventions for changing lifestyle and diet of persons with prediabetes in order to prevent them from developing diabetes and further advancing arteriosclerosis.

Relation of Carotid Artery Plaque to Coronary Heart Disease and Stroke in Chinese Patients: Does Hyperglycemia Status Matter?

“…In a study of Chinese participants free of cardiovascular disease at baseline, CAP was associated with increased CHD and stroke events during a median 10.5 year follow up [29]. Among 12 033 Japanese urban workers and their families, prediabetes mellitus were significantly associated with arterial stiffness and atherosclerosis [32]. Our study provided strong evidence that CAP significantly predicts incident CHD and stroke events in an hyperglycemia Chinese population.…”

“…Prediabetes were considered to accelerate arteriosclerosis leading to coronary heart disease and stroke [30,31]. The extent of subclinical arteriosclerosis was moderately enhanced among persons with prediabetes and was further advanced among persons with diabetes [32]. Endothelial cell-specific molecule 1 (ESM-1) is a new biomarker of endothelial dysfunction, which is involved in the pathogenesis of atherosclerosis and stress induced hyperglycemia in patients.…”

“…So there is significant positive association between CAP complicated with hyperglycemia and CHD as well as stroke. Few studies have examined the role of CAP complicated with hyperglycemia in predicting CVD events in Asian populations [29,30,32]. In a study of Chinese participants free of cardiovascular disease at baseline, CAP was associated with increased CHD and stroke events during a median 10.5 year follow up [29].…”

Incidence and risk factors of vascular complications in people with impaired fasting glucose: a national cohort study in Korea

“…Diabetic complications involving atherosclerotic diseases have been more concerning than glucose-centric small vessel diseases 17,18 , and the advancement of arteriosclerosis among prediabetic and diabetic patients have been much faster than that in normal individuals. Another study supported that this accelerated progression of arteriosclerosis often lead to coronary heart disease and stroke 19 , reporting an increased CVD risk in IFG and DM patients with adjusted HR of 1.03 (95% CI 1.09-1.28) and 1.39 (95% CI 1.33-1.46), respectively. In line with this, our cohort study confirmed that efforts to lower blood sugar levels to normal ranges can reduce the risk of CVD.…”

Diagnosis of Macrovascular Complications in Diabetes Mellitus Using Arterial Stiffness Measured by the Cardio-Ankle Vascular Index

“…CAVI was shown in to be high with diabetic patients in all ages ( Figure 5). Furthermore, Namekata reported that CAVI was high in prediabetic condition as well as diabetic condition [12]. Especially, CAVI showed high value in diabetic retinopathy, nephropathy and macroangiopathy.…”