Key result
Pre-diabetes is not linked to CACS ≥100 versus normoglycemia despite increased arterial stiffness.
Why the study?
It was unknown whether increased arterial stiffness and subclinical atherosclerosis in the coronary arteries differ at different stages of dysglycaemia.
Cohort (n=9,379)
Increased arterial stiffness and subclinical coronary atherosclerosis are present in early stages of dysglycaemia, though the overlap between these markers of vascular damage is small.
Answers are grounded in this paper and cite their sources.
Pre-diabetes links to stiffness but not calcification; leaves open staged vascular damage and need for prospective trials.
AIM: Our aim was to investigate in a large population-based cohort study whether increased arterial stiffness and subclinical atherosclerosis in the coronary arteries differ at different stages of dysglycaemia. METHODS: Data were obtained from SCAPIS, a population-based cohort of participants 50-64 years. The study population of 9379 participants was categorised according to glycaemic status: normoglycaemic, pre-diabetes (fasting glucose: 6.1-6.9 mmol/L and/or HbA1c 6%-6.4%) and diabetes. Pulse wave velocity (PWV) was measured by the SphygmoCor XCEL system and arterial stiffness was defined by PWV ≥10 m/s. Coronary artery calcium score (CACS) was assessed by coronary computed tomography and coronary artery calcification was defined by CACS ≥100. RESULTS: We identified 1964 (21%) participants with dysglycaemia, out of which 742 (7.9%) had diabetes mellitus. PWV ≥10 m/s was present in 808 (11%), 191 (16%), 200 (27%) and CACS ≥100 in 801 (11%), 190 (16%), 191 (28%) participants with normoglycaemia, pre-diabetes and diabetes, respectively, all, p < 0.001. The overlap between PWV ≥10 m/s and CACS ≥100 within each glycaemic category was 188 (2.5%), 44 (3.6%) and 77 (10) respectively. There was an association between glycaemic status and increased PWV in the fully adjusted models, but not for glycaemic status and CACS ≥100, where there was no difference for pre-diabetes compared to normoglycaemia, OR 1.2 (95% CI 0.98-1.4). In the total study population, there was an association between HbA1c and PWV after adjustment, p < 0.001. CONCLUSIONS: Our results show that increased arterial stiffness and subclinical coronary artery atherosclerosis are present in the early stages of dysglycaemia, but the overlap between markers of major subclinical vascular damage was small in all glycaemic categories. This could be explained by different pathways in the pathogenesis of arterial stiffness or atherosclerosis in the coronary arteries.
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Cederqvist et al. (2023) conducted a cohort in Dysglycaemia (n=9,379). Pre-diabetes vs. Normoglycaemia was evaluated on Coronary artery calcium score (CACS) ≥100 (OR 1.2, 95% CI 0.98-1.4). Pre-diabetes was not significantly associated with a coronary artery calcium score ≥100 compared to normoglycaemia (OR 1.2; 95% CI 0.98-1.4), despite increased arterial stiffness.
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