title: Association between hemoglobin A1c and carotid atherosclerosis in rural community-dwelling elderly Japanese men.
abstract: BACKGROUND
  Recent studies have reported an association between both higher and lower levels of hemoglobin A1c (HbA1c) and higher mortality of diabetes patients. Like diabetes, carotid atherosclerosis is a well known lifestyle-related disease. However, no studies have yet reported an association between HbA1c levels and carotid atherosclerosis.
  
  
  METHODS
  We conducted a cross-sectional study of 1,150 Japanese elderly men aged ≥60 years who were undergoing general health checkups. Carotid atherosclerosis was defined as a carotid intima-media thickness (CIMT) ≥1.1 mm. Since body mass index (BMI) is regarded as a cardiovascular risk factor that exerts a strong influence on both HbA1c levels and carotid atherosclerosis, we performed a stratified analysis of this risk based on BMI.
  
  
  RESULTS
  Using the intermediate HbA1c quintile as a reference group, the groups in the lowest HbA1c quintiles showed a significantly higher risk of carotid atherosclerosis in patients with low BMI (≤23 kg/m(2)) vs. no increased risk in those with high BMI (>23 kg/m(2)). The association of HbA1c with carotid atherosclerosis became slightly stronger when these analyses were limited to subjects who were not taking glucose-lowering medications or medications for hyperlipidemia and cardiovascular disease. After adjusting for classical cardiovascular risk factors, adjusted odds ratios (ORs) for carotid atherosclerosis were 1.36 (0.84 to 2.20) for total subjects, 2.29 (1.12 to 4.66) for low-BMI groups, and 0.68 (0.33 to 1.41) for high-BMI groups.
  
  
  CONCLUSIONS
  Lower HbA1c level is a significant risk factor for carotid atherosclerosis in rural community-dwelling elderly Japanese men with low, but not high BMI, particularly in those not taking glucose-lowering medication.
authors.affiliation: Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan. simizicyuu@yahoo.co.jp.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Shimizu
authors.affiliation: Department of Island and Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan. mio@msb.biglobe.ne.jp.
authors.forename: Mio
authors.initials: M
authors.lastname: Nakazato
authors.affiliation: Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan. fluctuat_nec_mergitur_j18@yahoo.co.jp.
authors.forename: Shimpei
authors.initials: S
authors.lastname: Sato
authors.affiliation: Department of Island and Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan. jun_koyamatsu@yahoo.co.jp.
authors.forename: Jun
authors.initials: J
authors.lastname: Koyamatsu
authors.affiliation: Department of Island and Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan. hiroymsk@nagasaki-u.ac.jp.
authors.forename: Hirotomo
authors.initials: H
authors.lastname: Yamanashi
authors.affiliation: Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan. nmako@hotmail.com.
authors.forename: Mako
authors.initials: M
authors.lastname: Nagayoshi
authors.affiliation: Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan. ko-kado@remus.dti.ne.jp.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kadota
authors.affiliation: Department of Global Health, Medicine and welfare, Atomic bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. naomin@nagasaki-u.ac.jp.
authors.forename: Naomi
authors.initials: N
authors.lastname: Hayashida
authors.affiliation: Center for Health and Community Medicine, Nagasaki University, Nagasaki, Japan. hiroymsk@nagasaki-u.ac.jp.
authors.forename: Hironori
authors.initials: H
authors.lastname: Yamasaki
authors.affiliation: Department of Internal Medicine, Nagasaki National Hospital, Nagasaki, Japan. tantan811@yahoo.co.jp.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Kusano
authors.affiliation: Department of Global Health, Medicine and welfare, Atomic bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. takamura@nagasaki-u.ac.jp.
authors.forename: Noboru
authors.initials: N
authors.lastname: Takamura
authors.affiliation: Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. kiyoshi@nagasaki-u.ac.jp.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Aoyagi
authors.affiliation: Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan. tmaeda@nagasaki-u.ac.jp.|Department of Island and Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan. tmaeda@nagasaki-u.ac.jp.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Maeda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000097:blood* / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D012424:Rural Population / Q000706:statistics & numerical data
chemical_list: D006442:Glycated Hemoglobin