title: Subclinical Atherosclerosis Is Inversely Associated With Gray Matter Volume in African Americans With Type 2 Diabetes.
abstract: OBJECTIVE
  Relative to European Americans, African Americans manifest lower levels of computed tomography-based calcified atherosclerotic plaque (CP), a measure of subclinical cardiovascular disease (CVD). Potential relationships between CP and cerebral structure are poorly defined in the African American population. We assessed associations among glycemic control, inflammation, and CP with cerebral structure on MRI and with cognitive performance in 268 high-risk African Americans with type 2 diabetes.
  
  
  METHODS
  Associations among hemoglobin A1c (HbA1c), C-reactive protein (CRP), and CP in coronary arteries, carotid arteries, and the aorta with MRI volumetric analysis (white matter volume, gray matter volume [GMV], cerebrospinal fluid volume, and white matter lesion volume) were assessed using generalized linear models adjusted for age, sex, African ancestry proportion, smoking, BMI, use of statins, HbA1c, hypertension, and prior CVD.
  
  
  RESULTS
  Participants were 63.4% female with mean (SD) age of 59.8 years (9.2), diabetes duration of 14.5 years (7.6), HbA1c of 7.95% (1.9), estimated glomerular filtration rate of 86.6 mL/min/1.73 m(2) (24.6), and coronary artery CP mass score of 215 mg (502). In fully adjusted models, GMV was inversely associated with coronary artery CP (parameter estimate [β] -0.47 [SE 0.15], P = 0.002; carotid artery CP (β -1.92 [SE 0.62], P = 0.002; and aorta CP [β -0.10 [SE 0.03] P = 0.002), whereas HbA1c and CRP did not associate with cerebral volumes. Coronary artery CP also associated with poorer global cognitive function on the Montreal Cognitive Assessment.
  
  
  CONCLUSIONS
  Subclinical atherosclerosis was associated with smaller GMV and poorer cognitive performance in African Americans with diabetes. Cardioprotective strategies could preserve GMV and cognitive function in high-risk African Americans with diabetes.
authors.affiliation: Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC Center for Diabetes Research and Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC bfreedma@wakehealth.edu.
authors.forename: Barry I
authors.initials: BI
authors.lastname: Freedman
authors.affiliation: Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Jasmin
authors.initials: J
authors.lastname: Divers
authors.affiliation: Advanced Neuroscience Imaging Research Laboratory, Department of Radiologic Sciences, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Whitlow
authors.affiliation: Center for Diabetes Research and Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Donald W
authors.initials: DW
authors.lastname: Bowden
authors.affiliation: Center for Diabetes Research and Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Nicholette D
authors.initials: ND
authors.lastname: Palmer
authors.affiliation: Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: S Carrie
authors.initials: SC
authors.lastname: Smith
authors.affiliation: Center for Diabetes Research and Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Jianzhao
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Register
authors.affiliation: Department of Radiology, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: J Jeffrey
authors.initials: JJ
authors.lastname: Carr
authors.affiliation: Advanced Neuroscience Imaging Research Laboratory, Department of Radiologic Sciences, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Wagner
authors.affiliation: Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Department of Internal Medicine, Winston-Salem, NC.
authors.forename: Jeff D
authors.initials: JD
authors.lastname: Williamson
authors.affiliation: Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Department of Internal Medicine, Winston-Salem, NC.
authors.forename: Kaycee M
authors.initials: KM
authors.lastname: Sink
authors.affiliation: Advanced Neuroscience Imaging Research Laboratory, Department of Radiologic Sciences, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Maldjian
mesh_terms: D001741:Black or African American; D000368:Aged; D050197:Atherosclerosis / Q000150:complications* / Q000175:diagnosis / Q000208:ethnology; D001786:Blood Glucose / Q000032:analysis; D003071:Cognition; D003072:Cognition Disorders / Q000209:etiology / Q000473:pathology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000208:ethnology; D005260:Female; D066128:Gray Matter / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000473:pathology; D011859:Radiography
chemical_list: D001786:Blood Glucose