title: Estimating the extent of subclinical arteriosclerosis of persons with prediabetes and diabetes mellitus among Japanese urban workers and their families: a cross-sectional study.
abstract: BACKGROUND
  Diabetes mellitus (hereafter called diabetes) is considered to accelerate arteriosclerosis leading to coronary heart disease and stroke. Thus, it is important to quantitatively estimate the extent of subclinical arteriosclerosis. A new method called cardio-ankle vascular index (CAVI) is developed to reflect arterial stiffness independently from blood pressure at the time of measurement. Then, we examined if CAVI scores could discriminate the extent of arteriosclerosis between persons with prediabetes (or borderline diabetes) and with diabetes among Japanese urban workers and their families.
  
  
  METHODS
  Subjects were 9881 men and 12033 women of company employees and their families who participated in cardiovascular disease screening in Japan. Persons having diabetes and prediabetes were defined based on the criteria set by American Diabetes Association. CAVI scores were measured by VaSera VS-1000. We applied the established age-sex specific cutoff points of CAVI scores above which were determined to be abnormally high or advanced level of arteriosclerosis. To examine the association of prediabetes and diabetes with CAVI scores, CAVI scores of screening participants were converted to a binary variable: 1 for less than cutoff points and 2 for equal or greater than cutoff points or abnormally high CAVI scores. Logistic regression method was used to examine the association of prediabetes and diabetes with CAVI scores after adjusting for major cardiovascular disease (CVD) risk factors.
  
  
  RESULTS
  Prevalence of abnormally high CAVI scores was significantly higher after 40 years of age among persons with diabetes than either among persons with prediabetes or among normal persons in both genders. Significantly elevated odds ratios (ORs) of abnormally high CAVI scores appeared among persons with prediabetes: 1.29 (95 % confidence interval (CI), 1.11-1.48) for men and 1.14 (CI, 1.01-1.28) for women, and among persons with diabetes: 2.41 (CI, 1.97-2.95) for men and 2.52 (CI, 1.94-3.28) for women.
  
  
  CONCLUSIONS
  The extent of subclinical arteriosclerosis (including arterial stiffness and atherosclerosis) was moderately enhanced among persons with prediabetes and was further advanced among persons with diabetes. Thus, it is important to introduce earlier interventions for changing lifestyle and diet of persons with prediabetes in order to prevent them from developing diabetes and further advancing arteriosclerosis.
authors.affiliation: Pacific Rim Disease Prevention Center, P.O.Box 25444, Seattle, WA, 98165-2344, USA. namekata@comcast.net.|Department of Health Services, School of Public Health, University of Washington, Box 357660, Seattle, WA, 98195-7660, USA. namekata@comcast.net.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Namekata
authors.affiliation: Department of Vascular Function, Sakura Hospital Medical Center, Toho University, 546-1 Shizu, Sakura City, Chiba, 285-8741, Japan. kshirai@kb3.so-net.ne.jp.
authors.forename: Kohji
authors.initials: K
authors.lastname: Shirai
authors.affiliation: Department of Health and Nutrition, University of Niigata Prefecture, 471 Ebigase, Higashi-ku, Niigata City, Niigata, 950-8680, Japan. tanabe@unii.ac.jp.
authors.forename: Naohito
authors.initials: N
authors.lastname: Tanabe
authors.affiliation: Department of Health and Nutrition, University of Niigata Prefecture, 471 Ebigase, Higashi-ku, Niigata City, Niigata, 950-8680, Japan. miyanisi@unii.ac.jp.
authors.forename: Kunio
authors.initials: K
authors.lastname: Miyanishi
authors.affiliation: Pacific Rim Disease Prevention Center, P.O.Box 25444, Seattle, WA, 98165-2344, USA. m_nakata@comcast.net.
authors.forename: Mitsuko
authors.initials: M
authors.lastname: Nakata
authors.affiliation: Japan Health Promotion Foundation, 1-24-4 Ebisu, Shibuya-ku, Tokyo, 150-0013, Japan. kenjii@e-kenkou21.or.jp.
authors.forename: Kenji
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Japan Health Promotion Foundation, 1-24-4 Ebisu, Shibuya-ku, Tokyo, 150-0013, Japan. arai@e-kenkou21.or.jp.
authors.forename: Chikao
authors.initials: C
authors.lastname: Arai
authors.affiliation: Japan Health Promotion Foundation, 1-24-4 Ebisu, Shibuya-ku, Tokyo, 150-0013, Japan. ishizuka@e-kenkou21.or.jp.
authors.forename: Norio
authors.initials: N
authors.lastname: Ishizuka
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001161:Arteriosclerosis / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D058070:Asymptomatic Diseases; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D005192:Family Health; D005260:Female; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016272:Occupational Health; D016017:Odds Ratio; D011236:Prediabetic State / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D015995:Prevalence; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012737:Sex Factors; D014504:Urban Health; D059289:Vascular Stiffness; D055815:Young Adult