title: Glucose intolerance, as reflected by hemoglobin A1c level, is associated with the incidence and severity of transplant coronary artery disease.
abstract: OBJECTIVE
  The possible effect of plasma hemoglobin A(1c) (HbA(1c)) on the development of transplant coronary artery disease (TxCAD) was investigated.
  
  
  BACKGROUND
  Glucose intolerance is implicated as a risk factor for TxCAD. However, a relationship between HbA(1c) and TxCAD has not been demonstrated.
  
  
  METHODS
  Plasma HbA(1c) was measured in 151 adult patients undergoing routine annual coronary angiography at a mean period of 4.1 years after heart transplantation. Intracoronary ultrasound (ICUS) was also performed in 42 patients. Transplant CAD was graded by angiography as none, mild (stenosis in any vessel < or =30%), moderate (31% to 69%), or severe (> or =70%) and was defined by ICUS as a mean intimal thickness (MIT) > or =0.3 mm in any coronary artery segment. The association between TxCAD and established risk factors was examined.
  
  
  RESULTS
  Plasma HbA(1c) increased with the angiographic grade of TxCAD (5.6%, 5.8%, 6.4%, and 6.2% for none, mild, moderate, and severe disease, respectively; p < 0.05 for none vs. moderate or severe) and correlated with disease severity (r = 0.24, p < 0.05). The HbA(1c) level was higher in patients with MIT > or =0.3 mm than in those with MIT <0.3 mm (6.4% vs. 5.7%, p < 0.05). Multivariate logistic regression analysis identified HbA(1c) as an independent predictor of TxCAD, as detected by angiography or ICUS (odds ratios 1.9 and 2.4, 95% confidence intervals 1.5 to 6.3 [p = 0.010] and 1.3 to 4.2 [p < 0.005], respectively).
  
  
  CONCLUSIONS
  Persistent glucose intolerance, as reflected by plasma HbA(1c), is associated with the occurrence of TxCAD and may play an important role in its pathogenesis.
authors.affiliation: Department of Cardiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Kato
authors.forename: Michael C Y
authors.initials: MC
authors.lastname: Chan
authors.forename: Shao-Zhou
authors.initials: SZ
authors.lastname: Gao
authors.forename: John S
authors.initials: JS
authors.lastname: Schroeder
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Yokota
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Iwase
authors.forename: Akiko
authors.initials: A
authors.lastname: Noda
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Hunt
authors.forename: Hannah A
authors.initials: HA
authors.lastname: Valantine
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood* / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D005260:Female; D018149:Glucose Intolerance / Q000150:complications*; D006442:Glycated Hemoglobin / Q000378:metabolism*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D014280:Triglycerides / Q000097:blood; D014463:Ultrasonography
chemical_list: D001786:Blood Glucose; D002784:Cholesterol; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D014280:Triglycerides