Progression of coronary artery calcification is stronger in poorly than in well controlled diabetes: Results from the Heinz Nixdorf Recall Study.
To assess associations between HbA1c and progression of coronary artery calcification (CAC) in persons with and without diabetes.



In the Heinz Nixdorf Recall Study, a population-based cohort study in Germany (N=3453, aged 45-74years), CAC was assessed by electron-beam tomography at baseline and at 5-year follow-up. At baseline, participants were divided into five groups: poorly (HbA1c≥7.0%) and well (HbA1c<7.0%) controlled previously known diabetes (group I/II); no previously known diabetes with HbA1c ≥6.5% (group III), HbA1c 5.7-6.4% (group IV), and HbA1c <5.7% (group V). We fitted linear, logistic and robust Poisson regression models to assess associations between diabetes group and PF5(factor by which CAC after 5-year follow-up is larger than baseline CAC), and categories of CAC change, respectively.



Relative to group V, adjusted percentage increase of the geometric mean of PF5(95% CI) was: 69.1% (33.9%;113.6%), 15.4% (-5.6%;41.1%), -4.1% (-22.2%;18.2%), 4.2% (-5.4%;14.8%) for groups I-IV, respectively. The corresponding odds ratios for annual CAC increase ≥100 Agatston units (reference: <10) were 10.0 (4.8;20.6), 4.0 (2.1;7.6), 1.5 (0.7;3.2), and 1.1 (0.7;1.8).



In known diabetes, CAC progression was stronger in poor diabetes control. For newly detected diabetes diagnosed by HbA1c ≥6.5%, associations with CAC progression were weak.
Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany. Electronic address: bernd.kowall@uk-essen.de.
Bernd
B
Kowall
Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, University Duisburg-Essen, Essen, Germany.
Nils
N
Lehmann
West-German Heart and Vascular Center Essen, Department of Cardiology, University Clinic Essen, Essen, Germany.
Amir-Abbas
AA
Mahabadi
Center for Urban Epidemiology, Institute for Medical Informatics, Biometry, and Epidemiology, University Hospital Essen, Essen, Germany.
Susanne
S
Moebus
Alfred Krupp Hospital, Essen, Germany.
Thomas
T
Budde
Diagnosticum, Mülheim, Germany.
Rainer
R
Seibel
Department of Radiology and Microtherapy, University Witten/Herdecke, Bochum, Germany.
Dietrich
D
Grönemeyer
Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, University Duisburg-Essen, Essen, Germany.
Raimund
R
Erbel
Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, University Duisburg-Essen, Essen, Germany.
Karl-Heinz
KH
Jöckel
Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany; School of Public Health, Department of Epidemiology Boston University, 715 Albany Street, Talbot Building, Boston, MA 02118, USA.
Andreas
A
Stang
D000368:Aged; D015331:Cohort Studies; D000072226:Computed Tomography Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012307:Risk Factors; D061205:Vascular Calcification / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology
D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
Coronary artery calcification; Coronary artery calcium; Glycemic control; HbA1c; Type 2 diabetes