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Abstract
Background Brachial–ankle pulse wave velocity (baPWV) and cardio-ankle vascular index (CAVI) are indices of arterial stiffness, and several studies have used these indices. However, there is no comprehensive review of these parameters in the prognostic significance. Methods The aim of this study was to review the articles exploring the prognostic significance of these parameters. Articles demonstrating independent significance after multivariate analysis on the Cox proportional hazards model were defined as “successful.” The success rate was compared using Fisher’s exact test. In addition, multivariate logistic regression analysis was performed to explore the independent determinants of the success of prognostic prediction. Results The success rate of the baPWV articles (65.7% [46/70]) tended to be higher than that of the CAVI articles (40.0% [6/15]; P=0.083). Multivariate analysis demonstrated that log (number of patients) (OR 11.20, 95% CI 2.45–51.70, P=0.002) and dialysis population (OR 0.28, 95% CI 0.08–0.94, P=0.039) were positive and negative independent determinants of the success of prognostic prediction, respectively. In addition, after redefining two studies as the absence of arteriosclerosis obliterans (ASO) exclusion, baPWV (OR 3.36, 95% CI 0.86–13.20, P=0.083) and the existence of exclusion criteria of ASO (OR 3.08, 95% CI 0.96–9.93, P=0.060) exhibited statistical tendency in the multivariate analysis. Conclusion This study demonstrated that the number of study participants and dialysis population were the independent determinants of the success of prognostic prediction. This study also showed the importance of exclusion criteria of ASO when using these indices. In addition, a prospective large-scale study to confirm the superiority in the prognostic prediction of these indices is warranted.
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Affiliation(s)
- Dai Ato
- Gakujutsu Shien Co., Ltd, Tokyo, Japan,
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2
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Osawa K, Trejo MEP, Nakanishi R, McClelland RL, Blaha MJ, Blankstein R, McEvoy JW, Ceponiene I, Stein JH, Sacco RL, Polak JF, Budoff MJ. Coronary artery calcium and carotid artery intima-media thickness for the prediction of stroke and benefit from statins. Eur J Prev Cardiol 2018; 25:1980-1987. [PMID: 30183342 DOI: 10.1177/2047487318798058] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Current guidelines suggest treatment for many individuals who may never develop a stroke. We hypothesized that a combination of coronary artery calcification (CAC) and carotid artery intima-media thickness (C IMT) data could better individualize risk assessment for ischemic stroke and transient ischemic attack events. METHODS A total of 4720 individuals from the Multi-Ethnic Study of Atherosclerosis were evaluated for ischemic stroke and transient ischemic attack. Cox proportional hazards models for time to incident ischemic stroke/transient ischemic attack were used to examine CAC and CIMT as ischemic stroke/transient ischemic attack predictors in addition to traditional risk factors. We calculated the 10-year number needed to treat by applying the benefit observed in ASCOT-LLA to the observed event rates within CAC and CIMT strata. RESULTS Median follow-up was 13.1 years. Compared with individuals with no CAC and with CIMT ≤ 75th percentile, stroke/transient ischemic attack risk increased progressively with each CAC category (0, 1-100, >100) among individuals with CIMT > 75th percentile. Among participants eligible for statin therapy based on the 2013 atherosclerotic cardiovascular disease (ASCVD) guidelines (ASCVD risk of >5%), 739/2906 (25%) had no CAC and CIMT ≤ 75th percentile and an observed ischemic stroke/transient ischemic attack rate of 2.49 per 1000 person-years. The predicted 10-year number needed to treat was 292 for no CAC and CIMT ≤ 75th percentile and 57 for CAC > 100 and CIMT > 75th percentile. CONCLUSION The combination of CIMT and CAC could serve to further refine risk calculation for ischemic stroke/transient ischemic attack prevention and may prioritize those in most need of statin therapy to reduce ischemic stroke/transient ischemic attack risk.
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Affiliation(s)
- Kazuhiro Osawa
- 1 LA Biomedical Research Institute at Harbor University of California Los Angeles, Torrance, USA
| | | | - Rine Nakanishi
- 1 LA Biomedical Research Institute at Harbor University of California Los Angeles, Torrance, USA
| | | | - Michael J Blaha
- 3 Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, USA
| | - Ron Blankstein
- 4 Cardiovascular Division, Department of Medicine, and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - John W McEvoy
- 3 Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, USA
| | - Indre Ceponiene
- 1 LA Biomedical Research Institute at Harbor University of California Los Angeles, Torrance, USA.,5 Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - James H Stein
- 6 University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Ralph L Sacco
- 7 Departments of Neurology and Public Health Sciences, Miller School of Medicine, University of Miami, USA
| | | | - Matthew J Budoff
- 1 LA Biomedical Research Institute at Harbor University of California Los Angeles, Torrance, USA
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3
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Gepner AD, Young R, Delaney JA, Budoff MJ, Polak JF, Blaha MJ, Post WS, Michos ED, Kaufman J, Stein JH. Comparison of Carotid Plaque Score and Coronary Artery Calcium Score for Predicting Cardiovascular Disease Events: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2017; 6:e005179. [PMID: 28196817 PMCID: PMC5523788 DOI: 10.1161/jaha.116.005179] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 01/11/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Coronary artery calcium (CAC) predicts coronary heart disease (CHD) events better than carotid wall plaque presence; however, differences in the utility of CAC burden and carotid plaque burden across the spectrum of cardiovascular disease (CVD) events is unknown. METHODS AND RESULTS CVD, CHD and stroke/transient ischemic attack (TIA) events were evaluated prospectively in a multiethnic cohort without CVD at baseline. Carotid plaque score was determined by the number of ultrasound-detected plaques in the common, bifurcation, and internal carotid artery segments. CAC was detected by computed tomography. Predictive values were compared using Cox proportional hazards models, C-statistics, and net reclassification, adjusting for traditional CVD risk factors. At baseline, the 4955 participants were mean (SD) 61.6 (10.1) years old and 52.8% female; 48.9% had CAC >0 and 50.8% had at least 1 carotid plaque. After 11.3 (3.0) years of follow-up, 709 CVD, 498 CHD, and 262 stroke/TIA events occurred. CAC score compared to carotid plaque score was a stronger predictor of CVD (hazard ratio [HR], 1.78; 95% CI, 1.16-1.98; P<0.001 vs HR, 1.27; 95% CI, 1.16-1.40; P<0.001) and CHD events (HR, 2.09; 95% CI, 1.84-2.38; P<0.001 vs HR, 1.35; 95% CI, 1.21-1.51; P<0.001). CAC score and carotid plaque score were weak predictors of stroke/TIA. CAC score had better reclassification statistics than carotid plaque score, except for stroke/TIA, which had similar predictive values. CONCLUSIONS CAC score improved prediction, discrimination, and reclassification of CVD and CHD better than carotid ultrasound measures, although prediction and discrimination were similar for stroke/TIA.
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Affiliation(s)
- Adam D Gepner
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | | | | | | | | | | | | | | | - James H Stein
- University of Wisconsin School of Medicine and Public Health, Madison, WI
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4
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B-flow imaging estimation of carotid and femoral atherosclerotic plaques: vessel walls rheological damage or strong predictor of cardiovascular mortality in chronic dialysis patients. Int Urol Nephrol 2016; 48:1713-20. [DOI: 10.1007/s11255-016-1393-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
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5
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Joo HJ, Cho SA, Cho JY, Lee S, Park JH, Hwang SH, Hong SJ, Yu CW, Lim DS. Brachial-Ankle Pulse Wave Velocity is Associated with Composite Carotid and Coronary Atherosclerosis in a Middle-Aged Asymptomatic Population. J Atheroscler Thromb 2016; 23:1033-46. [PMID: 27251176 PMCID: PMC5090810 DOI: 10.5551/jat.33084] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Aim: Although arterial stiffness has been associated with the development of atherosclerosis, the role of brachial-ankle pulse wave velocity (baPWV) for diagnosing composite coronary and carotid atherosclerosis has not been completely elucidated. Method: We enrolled 773 asymptomatic individuals who were referred from 25 public health centers in Seoul and who underwent carotid ultrasonography and coronary computed tomography. Noninvasive hemodynamic parameters, including baPWV, were also measured. Composite coronary and carotid atherosclerosis was defined as follows: 1) coronary artery calcium (CAC) score ≥ 100, 2) coronary artery stenosis (CAS) ≥ 50% of diameter stenosis, 3) carotid intima medial thickness (CIMT) ≥ 0.9 mm, or 4) presence of carotid artery plaque (CAP). Results: The incidence of composite coronary and carotid atherosclerosis was 28.2%. Coronary atherosclerosis (CAC and CAS) was significantly associated with carotid atherosclerosis (CIMT and CAP). Subjects with higher baPWV (highest quartile) had a higher prevalence of composite coronary and carotid atherosclerosis (p < .001). Although multivariate analysis failed to show baPWV as an independent predictor for composite atherosclerosis, baPWV had moderate diagnostic power to detect a subject with more than two positive subclinical atherosclerosis exams [area under the curve (AUC), 0.692]. Conclusion: baPWV was associated with the composite coronary and carotid atherosclerotic burden in a community-based asymptomatic population.
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Affiliation(s)
- Hyung Joon Joo
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital
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6
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Pulse wave velocity of the leg minus that of the arm measured with a custom device correlates to the coronary calcium quantification. Rev Clin Esp 2016. [DOI: 10.1016/j.rceng.2016.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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7
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Wang G, Wu Y, Zhang Z, Zheng X, Zhang Y, Liang M, Yuan H, Shen H, Li D. Effect of heart rate on the diagnostic accuracy of 256-slice computed tomography angiography in the detection of coronary artery stenosis: ROC curve analysis. Exp Ther Med 2016; 11:1937-1942. [PMID: 27168831 DOI: 10.3892/etm.2016.3150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 05/15/2015] [Indexed: 12/17/2022] Open
Abstract
The aim of the present study was to investigate the effect of heart rate (HR) on the diagnostic accuracy of 256-slice computed tomography angiography (CTA) in the detection of coronary artery stenosis. Coronary imaging was performed using a Philips 256-slice spiral CT, and receiver operating characteristic (ROC) curve analysis was conducted to evaluate the diagnostic value of 256-slice CTA in coronary artery stenosis. The HR of the research subjects in the study was within a certain range (39-107 bpm). One hundred patients suspected of coronary heart disease underwent 256-slice CTA examination. The cases were divided into three groups: Low HR (HR <75 bpm), moderate HR (75≤ HR <90 bpm) and high HR (HR ≥90 bpm). For the three groups, two observers independently assessed the image quality for all coronary segments on a four-point ordinal scale. An image quality of grades 1-3 was considered diagnostic, while grade 4 was non-diagnostic. A total of 97.76% of the images were diagnostic in the low-HR group, 96.86% in the moderate-HR group and 95.80% in the high-HR group. According to the ROC curve analysis, the specificity of CTA in diagnosing coronary artery stenosis was 98.40, 96.00 and 97.60% in the low-, moderate- and high-HR groups, respectively. In conclusion, 256-slice coronary CTA can be used to clearly show the main segments of the coronary artery and to effectively diagnose coronary artery stenosis. Within the range of HRs investigated, HR was found to have no significant effect on the diagnostic accuracy of 256-slice coronary CTA for coronary artery stenosis.
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Affiliation(s)
- Gang Wang
- Department of Radiology, People's Hospital of Dongguan, Dongguan, Guangdong 523000, P.R. China
| | - Yifen Wu
- Department of Oncology, People's Hospital of Dongguan, Dongguan, Guangdong 523000, P.R. China
| | - Zhentao Zhang
- Department of Radiology, People's Hospital of Dongguan, Dongguan, Guangdong 523000, P.R. China
| | - Xiaolin Zheng
- Department of Radiology, People's Hospital of Dongguan, Dongguan, Guangdong 523000, P.R. China
| | - Yulan Zhang
- Department of Radiology, People's Hospital of Dongguan, Dongguan, Guangdong 523000, P.R. China
| | - Manqiu Liang
- Department of Radiology, People's Hospital of Dongguan, Dongguan, Guangdong 523000, P.R. China
| | - Huanchu Yuan
- Department of Radiology, People's Hospital of Dongguan, Dongguan, Guangdong 523000, P.R. China
| | - Haiping Shen
- Department of Radiology, People's Hospital of Dongguan, Dongguan, Guangdong 523000, P.R. China
| | - Dewei Li
- Department of Radiology, People's Hospital of Dongguan, Dongguan, Guangdong 523000, P.R. China
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Rico Martín S, de Nicolás Jiménez JM, Moyano Calvente SL, Mogollón Jiménez MV, Vega Fernández J, Calderón García JF, Bacaicoa Lopez de Sabando MA, Tardio M, Sánchez Muñoz-Torrero JF. [Pulse wave velocity of the leg minus that of the arm measured with a custom device correlates to the coronary calcium quantification]. Rev Clin Esp 2016; 216:191-7. [PMID: 26915681 DOI: 10.1016/j.rce.2016.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/15/2016] [Accepted: 01/17/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The pulse wave velocity (PWV) in the great arteries is an indicator of vascular risk. Our objective was to identify the PWV index between the arms and legs that best correlates with the coronary calcium quantification (CCQ) and to compare it with other methods. MATERIAL AND METHODS Eight-one patients without vascular disease underwent the following measurements: CCQ; carotid intima-media thickness (IMT); carotid-femoral PWV (cfPWV), using COMPLIOR; and PWV in the arms and legs, with our own device (abiPWV, ankle brachial index PWV). RESULTS The difference in PWVs between the leg and arm (l-a PWV) measured with abiPWV was the index that best correlated with CCQ (r=0.401, P<.001). The correlation between IMT and CCQ and between CF-PWV and CCQ were r=0.366, P=.001; and r=0.385, P=.001, respectively. For a CCQ score higher than 100 as a marker of significant coronary arteriosclerosis, the areas under the curve for l-a PWV, IMT and cfPWV were 0.721 (P=.002), 0.758 (P<.001) and 0.636 (P=.058), respectively. CONCLUSIONS For patients without vascular disease, the l-a PWV measured with abiPWV appears to be the index that best correlates with the CCQ. This association is comparable to that between IMT and CCQ and between cfPWV and CCQ. The abiPWV is an easy-to-use device that can help improve vascular risk stratification.
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Affiliation(s)
- S Rico Martín
- Facultad de Enfermería y Terapia Ocupacional, Universidad de Extremadura, Cáceres, España
| | | | | | | | - J Vega Fernández
- Servicio de Cardiología, Hospital San Pedro de Alcántara, Cáceres, España
| | - J F Calderón García
- Facultad de Enfermería y Terapia Ocupacional, Universidad de Extremadura, Cáceres, España
| | | | - M Tardio
- Escuela de Ingenería Industrial. Universidad de Extremadura, Badajoz, España
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9
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Lee JY, Ryu S, Lee SH, Kim BJ, Kim BS, Kang JH, Cheong ES, Kim JY, Park JB, Sung KC. Association between brachial-ankle pulse wave velocity and progression of coronary artery calcium: a prospective cohort study. Cardiovasc Diabetol 2015; 14:147. [PMID: 26538347 PMCID: PMC4632351 DOI: 10.1186/s12933-015-0311-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/28/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Few studies have investigated the association between coronary artery calcium (CAC) progression and arterial stiffness measured by brachial-ankle pulse wave velocity (baPWV). We examined the influence of the severity of baseline baPWV on CAC progression in a large prospective cohort. METHODS A total of 1600 subjects who voluntarily participated in a comprehensive health-screening program between March 2010 and December 2013 and had baseline baPWV as well as CAC on baseline and serial follow-up computed tomography performed approximately 2.7 ± 0.5 years apart were enrolled in the study. RESULTS A total of 1124 subjects were included in the analysis (1067 men; mean age, 43.6 ± 5.1 years). An increased CAC score was found in 318 subjects (28.3%) during the follow-up period. Baseline higher baPWV was significantly correlated with CAC progression, especially in subjects with third- and fourth-quartile values (adjusted odds ratio [OR] 2.04; 95% confidence interval [CI] 1.33-3.15 and OR 2.14; 95% CI 1.34-3.41, respectively) compared with the lowest-quartile values (P for trend <0.001). A similar effect was observed in diabetic subjects. Among the 835 subjects with a baseline CAC score = 0, progression to CAC score >0 was associated with male sex, diabetes, and higher baPWV. However, among the 289 individuals with a baseline CAC score >0, only the presence of CAC itself was predictive of CAC progression. CONCLUSIONS Higher arterial stiffness measured by baPWV could be significantly associated with CAC progression.
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Affiliation(s)
- Jong-Young Lee
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108, Pyung Dong, Jongro-Ku, Seoul, 110-746, Republic of Korea.
| | - Seungho Ryu
- Department of Occupational and Environmental Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Sung Ho Lee
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108, Pyung Dong, Jongro-Ku, Seoul, 110-746, Republic of Korea.
| | - Byung Jin Kim
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108, Pyung Dong, Jongro-Ku, Seoul, 110-746, Republic of Korea.
| | - Bum-Soo Kim
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108, Pyung Dong, Jongro-Ku, Seoul, 110-746, Republic of Korea.
| | - Jin-Ho Kang
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108, Pyung Dong, Jongro-Ku, Seoul, 110-746, Republic of Korea.
| | - Eun Sun Cheong
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108, Pyung Dong, Jongro-Ku, Seoul, 110-746, Republic of Korea.
| | - Jang-Young Kim
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea.
| | - Jeong Bae Park
- Department of Medicine/Cardiology, Cheil General Hospital, Dankook University College of Medicine, Seoul, Republic of Korea.
| | - Ki-Chul Sung
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108, Pyung Dong, Jongro-Ku, Seoul, 110-746, Republic of Korea.
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Sato T, Kameyama T, Inoue H. Association of reduced levels of serum 1,5-Anhydro-d-glucitol with carotid atherosclerosis in patients with type 2 diabetes. J Diabetes Complications 2014; 28:348-52. [PMID: 24560424 DOI: 10.1016/j.jdiacomp.2014.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 12/20/2013] [Accepted: 01/08/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND HbA1c level represents mean blood glycemic control. 1,5-Anhydro-d-glucitol (1,5-AG) level reflects glycemic fluctuations, a strong risk factor for the development of macroangiopathy. The present study investigated the relationship between serum 1,5-AG levels and macroangiopathy in patients with type 2 diabetes. METHODS A total of 115 consecutive patients with type 2 diabetes, aged 45-79 years, were included. HbA1c, 1,5-AG, and lipid profile were measured. Carotid maximum intima-media thickness (IMT) and plaque score (PS) were determined by carotid sonography. An 1,5-AG level < 14.2 μg/mL was used as a predictor of a post-challenge 2-h blood glucose level > 200 mg/dL. Patients were divided into four groups: A (n=32), HbA1c ≥ 6.5% and 1,5-AG<14.2 μg/mL; B (n=23), HbA1c ≥ 6.5% and 1,5-AG ≥ 14.2 μg/mL; C (n=24), HbA1c < 6.5% and 1,5-AG <14.2 μg/mL; and D (n=36), HbA1c < 6.5% and 1,5-AG ≥ 14.2 μg/mL. RESULTS HbA1c level had significant positive correlation with IMT and PS. 1,5-AG level had a significant negative correlation with PS. PS was significantly higher in group C than in group D, but similar to that in group B. In multivariate analysis, HbA1c (β=0.27, p=0.03) and 1,5-AG (β=-0.24, P=0.04) were independent determinants of PS. CONCLUSIONS 1,5-AG level might provide additional information to identify macroangiopathy of patients with type 2 diabetes, especially in those with excellent HbA1c levels.
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Affiliation(s)
- Takao Sato
- Itoigawa General Hospital, Niigata, Japan.
| | - Tomoki Kameyama
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Hiroshi Inoue
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
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