Key result
Glucose-lowering medications significantly decreased the risk of carotid atherosclerosis progression (HR 0.694) over 4 years in adults with baseline carotid plaque.
Why the study?
Few prospective studies have explored the incidence and determinants of carotid atherosclerosis progression, particularly the effects of diabetes treatments and glucose levels.
Do glucose-lowering medications reduce the progression of carotid atherosclerosis in middle-aged adults and elders?
Cohort (n=657)
Do glucose-lowering medications reduce the progression of carotid atherosclerosis in middle-aged adults and elders?
Hazard Ratio: 0.694 (95% CI 0.51–0.944)
p-value: p=0.020
Glucose-lowering medications are associated with a reduced risk of carotid atherosclerosis progression, potentially through mechanisms beyond just lowering glucose levels.
GLM use was associated with lower CAP risk; hypothesis-generating for glucose-independent effects, requiring randomized confirmation before practice change.
Background: Few prospective studies explored the incidence and determinant of carotid atherosclerosis (CA) progression (CAP). This community-based prospective study focused on the effects of diabetes mellitus (DM) treatments and glucose levels on CAP risks. Methods: We followed up a group of 657 CA-positive middle-aged adults and elders for CAP. CAP was defined as an increase in the total number of carotid plaque and/or an increase in diameter stenosis by at least 10%. Results: After 4.05 years of followed-up, CAP was detected in 364 (55.4%) subjects. The multivariable-adjusted hazard ratios (HRs) were 1.805 (95% confidence interval [CI]: 1.374-2.358) and 0.694 (95% CI: 0.510-0.944) for elevated fasting plasma glucose (eFPG; FPG≥100 mg/dL) and glucose-lowering medications (GLM), respectively. As compared to GLM-negative+eFPG-positive subjects, the multivariable-adjusted HRs were 0.497 (95% CI: 0.373-0.662), 0.537(95% CI: 0.306-0.942), and 0.586 (95% CI: 0.412-0.833) for GLM-negative+eFPG-negative, GLM-positive+eFPG-negative, and GLM-positive+ eFPG-positive subjects, respectively. The multivariable-adjusted risks of CAP were similar between GLM-negative+eFPG-negative and GLM-positive+ eFPG-positive subjects (p=0.77). Stratified analyses showed that the multivariable-adjusted HRs per 5.0 mg/dL increase in FPG were significantly increased among GLM-negative subjects (HR=1.131; 95% CI: 1.094-1.171) and non-significantly decreased among GLM-positive subjects (HR=0.985; 95% CI: 0.957-1.013). Conclusion: We found that more than 50% of CA-positive subjects had CAP in 4 years and higher FPG significantly increased and GLM significantly decreased the risks of CAP. Additionally, GLM and FPG demonstrated an interactive effect on CAP risks. It seems possible that GLM may induce effects beyond lowering glucose levels and subsequently lowers CAP risks.
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Chou et al. (2024) conducted a cohort in Carotid atherosclerosis (n=657). Glucose-lowering medications vs. No glucose-lowering medications was evaluated on Carotid atherosclerosis progression (increase in total number of carotid plaque and/or ≥10% increase in diameter stenosis) (HR 0.694, 95% CI 0.510-0.944, p=0.020). Glucose-lowering medications significantly decreased the risk of carotid atherosclerosis progression (HR 0.694) over 4 years in adults with baseline carotid plaque.
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