Elsevier

Atherosclerosis

Volume 207, Issue 1, November 2009, Pages 245-249
Atherosclerosis

Elevated one-hour post-load plasma glucose levels identifies subjects with normal glucose tolerance but early carotid atherosclerosis

https://doi.org/10.1016/j.atherosclerosis.2009.04.006Get rights and content

Abstract

Objective

To examine whether individuals with normal glucose tolerance (NGT), whose 1-h post-load plasma glucose is ≥155 mg/dl, or with impaired glucose tolerance (IGT) have an increased carotid intima–media thickness (IMT), as compared with NGT individuals with 1-h post-load plasma <155 mg/dl.

Methods

Atherosclerosis risk factors, oral glucose tolerance test (OGTT), and ultrasound manual measurement of IMT were analyzed in 400 non-diabetic Caucasians.

Results

As compared with individuals with a 1-h post-load plasma glucose <155 mg/dl, NGT individuals with a 1-h post-load plasma glucose ≥155 mg/dl exhibited higher hsCRP (2.0 ± 1.5 vs. 1.5 ± 1.0, P = 0.008), and IMT (0.82 ± 0.20 vs. 0.71 ± 0.16; P = 0.006), and lower insulin sensitivity (71 ± 39 vs. 105 ± 57; P < 0.0001), and IGF-1 levels (214 ± 88 vs. 176 ± 49; P < 0.03). No significant differences were observed in metabolic and cardiovascular risk factors between IGT and NGT subjects with a 1-h post-load glucose ≥155 mg/dl. Of the three glycemic parameters, 1-h and 2-h post-load glucose, but not fasting glucose, were significantly correlated with IMT. In a stepwise multivariate regression analysis in a model including age, gender, and a variety of atherosclerosis risk factors, the three variables that remained significantly associated with IMT were age (P < 0.0001), BMI (P < 0.0001), and 1-h post-load glucose (P = 0.02) accounting for 20.2% of its variation.

Conclusions

NGT subjects with a 1-h post-load glucose ≥155 mg/dl have an atherogenic profile similar to IGT individuals. These data suggest that a cutoff point of 155 mg/dl for the 1-h post-load glucose during OGTT may be helpful in the identification of NGT subjects at increased risk for cardiovascular disease.

Introduction

A body of evidence suggests that individuals with impaired glucose tolerance (IGT) are not only at increased risk for progression to type 2 diabetes but should also be considered at risk for atherosclerotic cardiovascular disease [1], [2]. However, longitudinal epidemiological studies have shown that 30–40% of individuals who develop type 2 diabetes have normal glucose tolerance (NGT) at baseline [4] several reports indicate a significant risk for cardiovascular disease even in subjects with NGT [1], [5], [6]. Because lifestyle changes and pharmacological intervention in subjects at high-risk for type 2 diabetes have consistently demonstrated benefit in reducing the incidence of the disease [7], [8], [9], [10] and its associated cardiovascular complications [11], [12], it would be important to identify individuals at NGT with increased risk for both clinical outcomes. Two recent studies have shown that a cutoff point of 155 mg/dl for the 1-h post-load plasma glucose during the oral glucose tolerance test (OGTT) is able to identify subjects with NGT at high-risk for future type 2 diabetes [13], [14]. Whether these subjects also have an increased risk for atherosclerotic cardiovascular disease is still unknown. Carotid intima–media thickness (IMT) is a well-established index of early atherosclerosis and is widely used as a surrogate marker for cardiovascular disease [15]. To address the question of whether elevated 1-h post-load plasma glucose levels identify subjects with NGT at risk for cardiovascular disease, we compared clinical characteristics, including classical and inflammatory cardiovascular risk factors, and carotid IMT, in a group of non-diabetic Caucasian subjects.

Section snippets

Study participants

The study group consisted of 400 Caucasian subjects participating to the CAtanzaro MEtabolic RIsk factors Study (CATAMERIS), a metabolic disease prevention campaign for cardio-metabolic risk factors as previously reported [16], [17]. Subjects, aged 21–70 years, were excluded if they had history of cardiovascular disease including peripheral atherosclerosis, chronic gastrointestinal diseases associated with malabsorption, chronic pancreatitis, history of any malignant disease, history of alcohol

Statistical analysis

Variables with skewed distribution including triglyceride, high-sensitive C reactive protein (hsCRP), and IGF-1 were natural log transformed for statistical analyses. A general linear model with post hoc Bonferroni correction for multiple comparisons were used to compare differences of continuous variables between groups. Partial correlation coefficients adjusted for age and gender were computed between variables. Relationships between variables were sought by stepwise multivariate linear

Results

Of 400 non-diabetic subjects examined, 80 had impaired glucose tolerance (IGT). A one-hour post-load plasma glucose cutoff point of 155 mg/dl during OGTT was used to divide subjects with NGT into two groups: 231 subjects with 1-h post-load plasma glucose <155 mg/dl, and 89 individuals with 1-h post-load plasma glucose ≥155 mg/dl. Table 1 shows the clinical characteristics and laboratory findings of the three study groups. Significant differences between the three groups were observed with respect

Discussion

Increasing evidence suggest that subjects who develop type 2 diabetes and cardiovascular disease can have common antecedents of metabolic origin. The American Diabetes Association has recognized the importance of identifying individuals who are at metabolic risk for both type 2 diabetes and cardiovascular disease and released a Consensus Statement focused on the pre-diabetic states of impaired fasting glucose (IFG) and IGT [19]. However, several prospective studies have shown that a significant

Acknowledgment

This study was in part supported by the European Community's FP6 EUGENE2 n° LSHM-CT-2004-512013 grant (G. Sesti).

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