title: 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.
abstract: OBJECTIVE
  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 >or=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
  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.
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Essen, Germany. susanne.moebus@uk-essen.de
authors.forename: S
authors.initials: S
authors.lastname: Moebus
authors.forename: A
authors.initials: A
authors.lastname: Stang
authors.forename: S
authors.initials: S
authors.lastname: Möhlenkamp
authors.forename: N
authors.initials: N
authors.lastname: Dragano
authors.forename: A
authors.initials: A
authors.lastname: Schmermund
authors.forename: U
authors.initials: U
authors.lastname: Slomiany
authors.forename: B
authors.initials: B
authors.lastname: Hoffmann
authors.forename: M
authors.initials: M
authors.lastname: Bauer
authors.forename: M
authors.initials: M
authors.lastname: Broecker-Preuss
authors.forename: K
authors.initials: K
authors.lastname: Mann
authors.forename: J
authors.initials: J
authors.lastname: Siegrist
authors.forename: R
authors.initials: R
authors.lastname: Erbel
authors.forename: K-H
authors.initials: KH
authors.lastname: Jöckel
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000473:pathology*; D001786:Blood Glucose / Q000032:analysis*; D001794:Blood Pressure; D015992:Body Mass Index; D002114:Calcinosis / Q000473:pathology*; D002784:Cholesterol / Q000097:blood; D003331:Coronary Vessels / Q000473:pathology*; D003924:Diabetes Mellitus, Type 2 / Q000473:pathology*; D003925:Diabetic Angiopathies / Q000473:pathology*; D005215:Fasting; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000473:pathology*; D012307:Risk Factors; D012727:Sex Characteristics
chemical_list: D001786:Blood Glucose; D002784:Cholesterol