title: Association of prediabetes by fasting glucose and/or haemoglobin A1c levels with subclinical atherosclerosis and impaired renal function: observations from the Dallas Heart Study.
abstract: BACKGROUND
  Prediabetes defined by fasting plasma glucose (FPG) and glycosylated haemoglobin (HbA1c) predicts incident diabetes, but their individual and joint associations with micro- and macro-vascular risk remain poorly defined.
  
  
  METHODS
  FPG, HbA1c, coronary artery calcium (CAC), carotid wall thickness, estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) were measured in adults free from prior diabetes or cardiovascular disease (CVD) in the Dallas Heart Study 2 (DHS-2), a population-based cohort study. Prediabetes was defined by FPG 100-125 mg/dL and/or HbA1c 5.7%-6.4%. Multivariable logistic regression was used to analyse associations of HbA1c and/or FPG in the prediabetes range with subclinical atherosclerosis and renal measures.
  
  
  RESULTS
  The study comprised 2340 participants, median age = 49 years; 60% women and 50% black. Those with prediabetes were older (52 vs 48 years), more often men (63% vs 53%), black (53% vs 47%) and obese (58% vs 40%; p < 0.001 for each). Prediabetes was captured by FPG alone (43%), HbA1c alone (30%) or both (27%). Those with prediabetes by HbA1c or FPG versus normal HbA1c/FPG had more CAC [odds ratio (OR) = 1.8; 95% confidence interval (CI) = 1.5-2.2], higher carotid wall thickness (1.32 vs 1.29 mm, p < 0.001), eGFR < 60 mL/min [OR = 1.6 (95% CI = 1.1-2.4)], UACR > 30 mg/dL [OR = 1.8 (95% CI = 1.2-2.7)] and a higher odds for the composite eGFR + UACR [chronic kidney disease (CKD) ≥ 2] [OR = 1.9 (95% CI = 1.5-2.6)]. After multivariable adjustment, none of these associations remained significant.
  
  
  CONCLUSIONS
  Prediabetes defined by HbA1c and/or FPG criteria is crudely associated with markers of diabetic macro- and micro-vascular disease, but not after statistical adjustment, suggesting the relationships are attributable to other characteristics of the prediabetes population.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Frank Y F
authors.initials: FY
authors.lastname: Xing
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Neeland
authors.forename: M Odette
authors.initials: MO
authors.lastname: Gore
authors.forename: Colby R
authors.initials: CR
authors.lastname: Ayers
authors.forename: Andre R M
authors.initials: AR
authors.lastname: Paixao
authors.forename: Aslan T
authors.initials: AT
authors.lastname: Turer
authors.forename: Jarett D
authors.initials: JD
authors.lastname: Berry
authors.forename: Amit
authors.initials: A
authors.lastname: Khera
authors.forename: James A
authors.initials: JA
authors.lastname: de Lemos
authors.forename: Darren K
authors.initials: DK
authors.lastname: McGuire
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D050197:Atherosclerosis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D001786:Blood Glucose / Q000032:analysis*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003925:Diabetic Angiopathies / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D042241:Early Diagnosis; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D015995:Prevalence; D051437:Renal Insufficiency / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D012307:Risk Factors; D012720:Severity of Illness Index; D013781:Texas / Q000453:epidemiology; D014504:Urban Health
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: HbA1c; impaired fasting glucose; nephropathy; prediabetes; subclinical atherosclerosis