Raised glucose in normal range may have vascular consequences
medwireNews: Elevated blood glucose within the normal range is associated with increasing arterial stiffness over the long term in participants of the Whitehall II study.
Among 4386 participants (74% men) without diabetes, blood glucose exposure averaged across visits in 2003–2004 and 2008–2009 was significantly associated with baseline arterial stiffness, represented by carotid femoral pulse wave velocity measurements (cfPWV).
This was true for all four glucometabolic measures used – fasting glucose, 2-hour glucose, glycated hemoglobin (HbA1c), and HOMA-insulin resistance – with a 1 standard deviation (SD) increase in each being associated with a cfPWV increase of between 0.05 and 0.15 m/s.
Carmel McEniery (University of Cambridge, UK) and co-researchers stress that these associations were independent of mean arterial pressure and heart rate – physiologic contributors to arterial stiffness – as well as age, gender, and ethnicity.
However, only HbA1c and HOMA-insulin resistance remained significantly associated with progression of arterial stiffness to the 2012–2013 follow-up, with each SD rise associated with respective 0.12 and 0.11 m/s increases.
“Our data suggest that higher average glucose levels may be causally related to accelerated vascular aging through long-term mechanisms rather than short-term dynamic changes in the arterial wall,” write the researchers in Diabetes Care.
“Improving glucometabolic status may thus represent a strategy to improve vascular health.”
The relationships with arterial stiffness progression persisted after further adjustment for a range of vascular risk factors, including systolic blood pressure, smoking, and cholesterol levels, and for antihypertensive medication use.
However, the association between HOMA-insulin resistance and arterial stiffness was lost after further adjustment for body mass index, suggesting to the researchers “that adiposity and insulin resistance share common pathways leading to aortic stiffening but that these pathways may be independent of glycemia.”
The team concludes: “Given that glucometabolic indices determine the development of diabetes up to 15 years in advance and cfPWV predicts future cardiovascular risk, we believe that our observations are clinically important and suggest that further mechanistic and intervention studies of arterial stiffening should examine factors related to longer-term glucometabolic status.
“These could involve lifestyle approaches and/or trials of glucose-lowering therapies in individuals without diabetes, which could ultimately influence public health strategies.”
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