title: Associations between blood glucose and carotid intima-media thickness disappear after adjustment for shared risk factors: the KORA F4 study.
abstract: OBJECTIVE
  The association between blood glucose and carotid intima-media thickness (CIMT) is considered to be established knowledge. We aimed to assess whether associations between different measures of glycaemia and CIMT are actually independent of anthropometric variables and metabolic risk factors. Moreover, we checked published studies for the adjustment for shared risk factors of blood glucose and CIMT.
  
  
  METHODS
  Fasting glucose, 2-hour glucose, HbA1c, and CIMT were measured in 31-81-years-old participants of the population-based Cooperative Health Research in the Region of Augsburg (KORA) F4 study in Southern Germany (n = 2,663). CIMT was assessed according to the Rotterdam protocol. Linear and logistic regression models with adjustment for age, sex, anthropometric measures, hypertension, and dyslipidaemia were fitted to assess the association between continuous measures of glycaemia, and categories of glucose regulation, respectively, with CIMT.
  
  
  RESULTS
  We found a 0.10 mm increase (95%-confidence interval: 0.08-0.12) in CIMT in subjects with compared to subjects without diabetes in crude analysis. This increase was not significant in age-sex adjusted models (p = 0.17). Likewise, neither impaired fasting glucose (p = 0.22) nor impaired glucose tolerance (p = 0.93) were associated with CIMT after adjustment for age, sex, and waist circumference. In multivariable adjusted models, age, sex, hypertension, waist circumference, HDL and LDL cholesterol, but neither fasting glucose nor 2-hour glucose nor HbA1c were associated with elevated CIMT. Literature findings are inconclusive regarding an independent association of glucose levels and CIMT.
  
  
  CONCLUSIONS
  CIMT is highly dependent on traditional cardiovascular risk factors, but no relationships between blood glucose and CIMT were found after adjustment for age, sex, and anthropometric variables.
authors.affiliation: Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany. bernd.kowall@ddz.uni-duesseldorf.de
authors.forename: Bernd
authors.initials: B
authors.lastname: Kowall
authors.forename: Nina
authors.initials: N
authors.lastname: Ebert
authors.forename: Cornelia
authors.initials: C
authors.lastname: Then
authors.forename: Joachim
authors.initials: J
authors.lastname: Thiery
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Koenig
authors.forename: Christa
authors.initials: C
authors.lastname: Meisinger
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Rathmann
authors.forename: Jochen
authors.initials: J
authors.lastname: Seissler
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D059168:Carotid Intima-Media Thickness; D005260:Female; D005858:Germany; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors
chemical_list: D001786:Blood Glucose