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1: Diabetologia. 2009 Jan;52(1):81-9. Epub 2008 Nov 1.
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Association of impaired fasting glucose and coronary artery calcification as a marker of subclinical atherosclerosis in a population-based cohort-results of the Heinz Nixdorf Recall Study.

Moebus S, Stang A, Möhlenkamp S, Dragano N, Schmermund A, Slomiany U, Hoffmann B, Bauer M, Broecker-Preuss M, Mann K, Siegrist J, Erbel R, Jöckel KH; Heinz Nixdorf Recall Study Group.

Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany, susanne.moebus@uk-essen.de.

AIMS/HYPOTHESIS: Atherosclerosis and cardiovascular diseases are often present at the time of diagnosis of type 2 diabetes mellitus. Whether subclinical atherosclerosis can be detected in the pre-diabetic (borderline fasting hyperglycemia) state is not clear. This study investigated the association of impaired fasting glucose (IFG) and coronary artery calcification (CAC), a marker of subclinical atherosclerosis, among participants without a history of coronary heart disease or manifest diabetes mellitus. METHODS: Study participants (aged 45-75 years) of the population-based Heinz Nixdorf Recall Study were categorised into those with normal fasting glucose (glucose <6.1 mmol/l) and those with IFG (glucose >/=6.1 to <7.0 mmol/l), excluding participants with a history of CHD or diabetes mellitus. CAC was assessed by electron-beam computed tomography, and risk factors were assessed by extended interviews, anthropometric measurements and laboratory tests. Various CAC cut-off points were used in multiple logistic and ordinal logistic regression models to estimate ORs and 95% CIs. RESULTS: Of the 2,184 participants, more men had IFG than did women (37% vs 22%). Participants with IFG showed a higher prevalence of CAC > 0 (men OR 1.90, 95% CI 1.33-2.70; women 1.63, 1.23-2.15). Risk factor adjustment weakened this association in both sexes (men 1.63, 1.12-1.36; women 1.26, 0.93-1.70). When the age- and sex-specific 75th percentile was used as the cut-off point for CAC, the association further decreased in men (1.10, 0.81-1.50), but became stronger in women (1.41, 1.02-1.94). CONCLUSIONS/INTERPRETATION: These data support the hypothesis that CAC is already present in the pre-diabetic state and that IFG has a modest and independent impact on the atherosclerotic process. Biological sex appears to modify the association between IFG and CAC.

PMID: 18979083 [PubMed - in process]