title: Hyperglycemia and arterial stiffness: the Atherosclerosis Risk in the Communities study.
abstract: OBJECTIVE
  Hyperglycemia has been associated with an increased risk of cardiovascular morbidity and mortality. Although numerous studies have demonstrated that hyperglycemia is associated with the atherosis component of atherosclerosis, limited studies have addressed the independent role of hyperglycemia in the pathophysiology of sclerotic vascular disease. We hypothesized that hyperglycemia, as assessed by hemoglobin A1c (HbA1c), would be independently associated two common indices of arterial stiffness (pressure-strain elastic modulus (Ep) and Young's elastic modulus (YEM)).
  
  
  METHODS
  We examined the cross-sectional association between HbA1c and arterial stiffness using B-mode ultrasound examination of the carotid artery in 9050 participants from the community-based Atherosclerosis Risk in Communities (ARIC) study. We used multivariable linear and logistic regression models to characterize the association between HbA1c and increased Ep and YEM.
  
  
  RESULTS
  Higher values of HbA1c were associated in a graded fashion with increased arterial stiffness (P-trend < 0.001 for both EP and YEM). After adjusting for traditional risk factors, increasing HbA1c deciles were significantly associated with elevated EP (OR for the highest decile of HbA1c compared to the lowest, 2.01, 95% CI: 1.30, 3.11) and YEM (OR = 1.71, 95% CI: 1.15, 2.55).
  
  
  CONCLUSIONS
  Elevated HbA1c is associated with measures of increased arterial stiffness, even after accounting for arterial wall thickness. This is consistent with the hypothesis that hyperglycemia contributes to arterial stiffness beyond its effects on atherosis and suggests that hyperglycemia is associated with altered material within the arterial wall.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. jrubink1@jhmi.edu
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rubin
authors.forename: Vijay
authors.initials: V
authors.lastname: Nambi
authors.forename: Lloyd E
authors.initials: LE
authors.lastname: Chambless
authors.forename: Michael W
authors.initials: MW
authors.lastname: Steffes
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Juraschek
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.forename: A Richey
authors.initials: AR
authors.lastname: Sharrett
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Selvin
mesh_terms: D050197:Atherosclerosis / Q000503:physiopathology*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D059168:Carotid Intima-Media Thickness; D055119:Elastic Modulus; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D006943:Hyperglycemia / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D059289:Vascular Stiffness
chemical_list: D006442:Glycated Hemoglobin